Robotic Pyleoplasty

What is pyeloplasty? We can tailor the drainage system of a kidney that is blocked by scarring or other anatomic problems.

Who needs pyeloplasty? Some people are born with a blockage of the ureter, other people develop a blockage. A partial blockage can get worse over time due to inflammation.

Wait. . . what? Ok, lets have an anatomy lesson:

The kidney filters the blood, and get rid of excess water and waste products in the blood: this is the urine.

The urine is filtered into the renal pelvis. The renal pelvis is a hollow space attached to the kidney. It normally tapers down like a funnel draining urine into the ureter

The ureter is a tube that runs between the kidney and the bladder. The place where the renal pelvis and the ureter join is called the uretero-pelvic junction (or “UPJ”). We are constantly making urine, which drips down the ureter. The urine is actually propelled down the ureter by rhythmic waves of contraction called peristalsis. We store the urine in the bladder so we aren’t constantly wetting ourselves.

Blockage of the uretero-pelvic junction is called a UPJ Obstruction (“a UPJO”). The causes of a UPJO are: an extra renal artery crossing in front of the UPJ and causing an obstruction, an area of the UPJ that is narrowed or does not undergo peristalsis, or a mass or compression from outside. Scarring from procedures can cause UPJO as well.

What are the symptoms of a UPJO? Often there are no symptoms, and theUPJO is only discovered because of abdominal imaging. Sometimes there is pain.

Why is there pain from a UPJO? If the urine is pushed along by waves of peristalsis and the rushing wave of fluid hits a blockage, the upstream ureter an renal pelvis are stretched. This stretching causes pain called “renal colic.”

I’ve heard of babies having colic. Is this the same thing? Sort of. Babies often have gas in their intestines, and the stretch of the bowels causes crampy pain called colic. Any pain caused by stretching of a hollow organ is called colic. The nerves inside of our body are not as specific for location as the nerves to our skin. So, the pain from renal colic typically causes pain in flank (side of the back) on the side of the obstruction, radiating down to the groin.

Can kidney stones cause renal colic? Absolutely. Stones form in the renal pelvis and they don’t usually cause obstruction unless they move into the more narrow ureter. Then there is renal colic which is severe, regardless of the size of the stone, until the stone is passed into the bladder. Renal colic is often accompanied by nausea and vomiting. There is usually no position of comfort.

Is the renal colic from a UPJO the same as from a stone? It can be. The colic from a stone tends to be more severe than from a UPJO. Also the colic from a UPJO can come and go. The stretch usually increases when the patient produces a lot of urine because they drink a lot of water, alchohol, caffeine, or medicine that causes the body to release water.

Can the blockage of UPJO get worse over time? Yes. This is probably due to repeated bouts of inflammation – the body’s response to injury. The urine upstream of a partial blockage doesn’t clear well – a condition called stasis. With stasis, more debris collects upstream of the blockage. There is a greater tendency to form stones in these conditIons. Bacteria can more readily grow in these conditions. All of these factors can cause inflammation which leads to swelling and scarring. A blockage that is not initially severe can become worse over time.

Don’t UPJ obstructions get better in children?

 

 

 

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