Muljibhai Patel Urological Hospital
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Pyeloplasty

What is it?

A ureteropelvic junction obstruction (UPJO) is a congenital narrowing or obstruction where the ureter meets the kidney. These obstructions develop prenatally as the kidney is forming. Studies confirm that it is more common in males and on the left side. However, both kidneys may be involved.This narrowing will not allow urine to drain from the kidney, causing hydronephrosis(kidney swelling).

With the use of pre-natal ultrasounds, hydronephrosis is often diagnosed as early as 15 weeks of fetal development. UPJO is the most common cause for pediatric hydronephrosis. Early detection allows for evaluation and treatmentsoon after birth.

Symptoms of theUPJO may be an abdominal mass, (felt on a routine exam by the primary care provider), a urinary tract infection with fever, belly pain or back (flank) pain. The flank pain may be present especially with increased fluid intake. Symptoms of a UPJO may not occur until the obstruction has progressed and some kidney damage has already occurred. Sometimes they are found after an injury to the back or abdomen occurs and imaging shows a swollen kidney.

How it is done?

UPJO can be diagnosed with different imaging methods depending upon the age of the infant or child. Commonly ordered radiology tests include renal / bladder ultrasound, x-ray voiding urethrogram (VCUG), and lasix renal scan.  

A VCUG (voiding cystourethrogram) will often be done at the same time as the renal ultrasound or soon after. A Lasix renal scan is a nuclear medicine study that is done to look at how much blockage is occurring in the kidney. Drainage times from both kidneys will show the amount of blockage and also how much work each kidney is doing.

Surgical treatment of UPJO is recommended in many cases to protect kidney function. Immediate surgery after birth is usually unnecessary. Most surgeries are done after the age of 4 weeks.

Pyeloplasty is the surgical repair of the kidney to drain and decompress the swollen kidney. During the surgery, the narrowed segment is removed. The ureter is then re-connected to the kidney. Your child may have a temporary drainage tube in the kidney. The surgery usually takes 3 to 3 1/2 hours. Your child will remain in the hospital for 3 to 4 days.Follow-up testing will include a renal ultrasound 1 to 3 months after the surgery. Your child will remain on a low dose of antibiotic, taken by mouth, to help prevent urinary tract infections.