Laparoscopic Pyeloplasty for PUJ Obstruction

What is PUJ obstruction?

This means a blockage of the flow of urine from part of the kidney known as the renal pelvis to the ureter, which is the tube that carries urine onwards to the bladder. This area is known as the pelviureteric junction (PUJ). The blockage is usually due to a narrow area in the PUJ.

What causes PUJ obstruction?

There is usually an abnormality in the structure of the wall of the PUJ. This can exist from birth or develop later in life secondary to other causes such as stones or, very rarely, cancer. In about one in three cases, the PUJ passes over a blood vessel known as a ‘crossing vessel’ and this may cause the obstruction sometimes also. Even if PUJ obstruction is present in birth, symptoms may not occur until later in life.

What is Laparoscopic Pyeloplasty Surgery?

Cutting out the PUJ obstruction and joining the kidney onto the ureter is called pyeloplasty. This has the best results and lasts for the longest period. This can be achieved through a traditional surgery (‘open pyeloplasty’) where large skin incision is done or bykeyhole surgery (‘laparoscopic pyeloplasty’).

Open Procedure

Laparoscopic Procedure

How is a Laparoscopic Pyeloplasty performed?

Three small skin incisions are made on the side of kidney. Laparoscopic instruments are inserted from these holes. The narrow part of the junction between the renal pelvis and the ureter is identified & excised . A new ‘join’ between the kidney and ureter is constructed. At the end of the procedure, there is usually a tube left inside the body near the site of the operation and this comes out through the skin (‘drain’). This is removed when fluid stops draining, which is usually after a day or so. There is another tube (‘catheter’) coming out from the bladder through the urethra and connected to a ‘catheter bag’. This is removed after a day or so also. The stent’ placed internally between the kidney and the bladder remains at the end of the operation and is removed later under local anaesthetic about 6 weeks after surgery.

What are the advantages of laparoscopic method of surgery?

  • Smaller incisions and better cosmetic appearance
  • Less pain
  • Reduced need for blood transfusion
  • Magnification and possibly better surgical connection between the ureter and bladder
  • Shorter time in hospital
  • Earlier return to normal activities