Pyelonephritis-ureteric junction (PUJ) obstruction is a narrowing at the point where the kidney joins the ureter (tube joining the kidney and bladder). It can be made narrow, which is usually first discovered in childhood, or even before birth on ante-natal scans. It can also develop at all ages. The narrowing blocks the kidney and can cause pain, infection, progressive loss of kidney function, or may cause no problems. Usually there is no serious underlying problems causing the narrowness, although rarely conditions such as kidney stones, infection or cancer can be the cause. The condition is diagnosed using scans such as a renogram, ultrasound and sometimes CT. Treatment can be monitoring if the condition causes no problems, but otherwise needs some type of surgery. The specific type of surgery that is most suitable will be discussed by your surgeon.
The most usual surgery used to treat this condition is Pyeloplasty. This involves cutting out the narrowed area of tube and stitching the kidney back onto the ureter tube. This is a major operation, and is not always successful. It used to be performed as an open operation, but the keyhole approach is now widely recognised as equally effective with a much shorter recovery time. There are alternatives to Pyeloplasty, but none are as successful. Alternatives may be suitable for selected cases, or for those not fit for a major operation. These alternative operations involve using a single telescope through the bladder and ureter (or sometimes through the kidney like PCNL) to either cut, laser or stretch with a balloon, the narrowed area. A ureteric stent is required for about 6 weeks after these types of surgery. An edited video of one of our surgeons performing a laparoscopic pyeloplasty follows:
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Why choose us?
Our consultants are recognised experts in the field of keyhole kidney surgery. They are regionally renowned for performing laparoscopic pyeloplasty. Indeed they have pioneered performing this operation as a day case procedure and have recently published the results.
Coming in for this procedure
Before the operation you will be invited to come to the hospital for a pre-operative assessment (including blood tests and heart trace). On the day of the operation you will be asked to give written consent for the operation. The operation is performed under general anaesthesia and usually takes about 2 hours. When you wake up pain is usually minimal and often controlled by tablets. Some patients are fit to go home on the day of surgery, but others stay overnight. A ureteric stent is left in the ureter after this surgery for about 4-6 weeks. There are risks and side effects associated with all forms of treatment and these should be carefully considered before surgery. Serious complications associated with major surgery (heart, lung, and thrombosis problems that could lead to death) are very rare. Serious bleeding, damage to the bowel or other internal organs is likewise rare. The commonest problems after this surgery are discomfort from the wounds and irritation of the bladder or urinary infection caused by the stent.
Follow up after this procedure
Many patients can start light work several weeks after the operation. The first hospital follow-up appointment is usually made at about 4-6 weeks to remove the ureteric stent (a procedure that is usually carried out under local anaesthetic). Further periodic review is then required to monitor progress and usually involves repeating the initial scans. Success rates for this type of surgery are high, but not universal.