In a healthy, functioning urinary system,

In a healthy, functioning urinary system, urine flows from the kidneys through thin muscular tubes called ureters and into the bladder. Once in the bladder, urine is stored until it is expelled from the body through the urethra during urination. This process helps maintain fluid balance and eliminate waste products from the body, but it can be easily disrupted. In some instances, one or more of the ureters can become blocked, which disrupts the flow of urine and can contribute to uncomfortable symptoms and eventual kidney damage. Luckily, this is treatable with a procedure called a pyeloplasty.

What is a Pyeloplasty?

A pyeloplasty is a surgical treatment performed to remove a blockage or repair the narrowing of a ureteropelvic junction (UPJ). This is the area in the urinary tract where the kidneys intersect with the ureters to drain urine into the bladder. Without the surgery, the urine can be pushed back into the kidneys, causing pain, inflammation, infection, and a gradual decline in kidney function. It can also cause swelling and the accumulation of urine in the kidney, which is called hydronephrosis. During a pyeloplasty, the surgeon removes or fixes the blockage or narrowing area of the UPJ, allowing urine to flow from the kidney to the bladder.

About 1 in every 1,500 children is born with a UPJ obstruction. However, their doctor may recommend active surveillance to see if it corrects early in life. If the obstruction remains after 18 months, a pyeloplasty is usually necessary. Adults and older children may also develop UPJ obstructions. If you or your child experiences kidney pain or discomfort, an ultrasound will be done to check for swelling.

Reasons for a Pyeloplasty

There are several reasons that someone may need a pyeloplasty. These include:

• UPJ Obstruction —The most common reason for pyeloplasty is an obstruction in the UPJ. One or both of the tubes that drain urine from the kidney are blocked, and without intervention, the risk of complications remains.
• UVJ Obstruction — The ureterovesical junction is the lower end of the ureter where it meets the bladder. Narrowing or obstruction can also occur here, which often results in recurrent urinary tract infections.
• Other Blockages — In some instances, an external force may put pressure on the ureter and cause a kink or block, which affects drainage. For example, a blood vessel that crosses over the top of a ureter can narrow, resulting in symptoms like kidney pain and discomfort. Other potential blockages could include those caused by polyps or tumors.
• Urethral Strictures — Scarring along the urethral lining can lead to urethral strictures. These essentially cause the small tubes to become even narrower, making it difficult to empty the bladder. Although this is usually treated by placing a stent inside the ureter, a pyeloplasty may also be performed.

Pyeloplasty Benefits vs. Risks

Although minimally invasive, pyeloplasty is still a surgical procedure that carries unique risks. The most common risks include:

• Infection
• Scarring
• Excessive bleeding
• Blood clots
• Hernias
• Bad reactions to anesthesia
• Damage to blood vessels
• Damage to nearby organs
• Need for additional surgery
• Urine leakage

Still, pyeloplasty is a surgical treatment to relieve pain and prevent kidney failure, so it's often considered necessary. Some of the advantages of pyeloplasty include pain relief, reduced swelling in the kidney and ureter, and improved overall function.

How to Prepare for a Pyeloplasty

Your doctor will give you instructions to help you prepare for a pyeloplasty. Typically speaking, this includes following a few directions. Most commonly, your doctor will ask you to:

• Fast (no food or water) for eight to twelve hours before the procedures
• Discontinue unnecessary medication on the day of the operation, or only take them with a small sip of water (do not stop taking any medications unless explicitly told to do so by your doctor)
• Prepare to stay in the hospital following the surgical procedure
• Ask a friend or family member to drive you home

How Can Pyeloplasty Surgery Be Performed?

Pyeloplasty is generally considered a minimally invasive procedure, but there are several options for individuals who need treatment. Most surgeries take about two to three hours, and you may be required to stay in the hospital for a few days after surgery. The different surgical options include:

Laparoscopic Pyeloplasty

During laparoscopic surgery, small incisions are made in the abdomen, through which a thin tube with a camera and specialized instruments are inserted. The surgeon then accesses the UPJ and removes the obstructed portion of the ureter before reconstructing it to allow for proper urine flow.

Endoscopic Surgery

In this procedure, a thin, flexible instrument called an endoscope is inserted through the urinary tract, typically via the urethra, to access the UPJ. The surgeon can visualize and navigate the obstruction using advanced surgical tools passed through the endoscope, often without external incisions. Normal urine flow is restored after removing the obstructed segment and reconstructing the ureteropelvic junction.