Minimally Invasive treatment of Ureteropelvic Junction Obstruction

Endopyelotomy

Ureteropelvic junction obstruction (UPJO) is a condition characterized by narrowing at the upper end of the ureter (tube draining urine from the kidney to the bladder) where it joins the renal pelvis (part of the kidney which transports urine to the ureter). This is usually a congenital condition (from birth) but often develops symptoms later in adult life. It can also develop as a result of injury, chronic infection or previous instrumentation of the urinary tract. Endopyelotomy is a minimally invasive endoscopic approach for treating UPJO in which the narrow obstructing portion of the ureteropelvic junction is incised (cut-open) with the help of special endoscopic instruments which can be inserted directly into the kidney through the back (percutaneous) or from below through the ureter (ureteroscopic). The incision results in widening of the narrowed passage and relief of obstruction. A ureteral stent (tube extending from the kidney to the bladder which provides drainage to the kidney and acts as a splint) is then placed to allow the incised area to heal adequately. The average hospital stay for this procedure is usually 2-3 days with minimal postoperative discomfort and early recovery. The ureteral stent is removed after 6 weeks, followed by a renal scan to confirm the success of the operation. Endopyelotomy is not ideal for all UPJ obstructions and careful patient selection is critical to ensure a good surgical outcome.

Laparoscopic/ robot-assisted pyeloplasty

Laparoscopic / robot-assisted pyeloplasty is a minimally invasive procedure used to treat Ureteropelvic Junction Obstruction, with a very high success rate (>95%). The surgery involves surgical reconstruction of the narrowed portion of the ureteropelvic junction. This is usually performed by excising (removing) the narrowed portion and reconnecting/reconstructing the two divided ends of the tube (dismembered pyeloplasty). The procedure is performed by using specialized instruments inserted through 3-4 small skin incisions as compared to the large incision of traditional surgery. The surgeon performs the surgery while watching the magnified images of the operative field on a monitor with the help of a telescope inserted into the patient’s abdomen, which is distended with carbon dioxide gas. Robot-assisted laparoscopic pyeloplasty is performed with the FDA approved surgical robot called the da Vinci robot. The surgeon controls the movements of the robotic arms attached to special laparoscopic instruments with wrist-like motion, which are inserted through small incisions in the body wall. The surgeon sits at the console and views the surgical field through a three-dimensional (3D) binocular display while manipulating the operating controls with the index finger and the thumb of each hand. Hand movements of the surgeon are sent to a computer processor which relays them via the robotic arms to fine instrument tips that, along with the optical elements, are placed inside the patient’s body through small incisions.

Robot-assisted urologic surgery imaging technology

The da Vinci robotic system’s advanced imaging technology delivers high definition, three-dimensional, full-color images of structures within the operative field. The dexterity of these special instruments along with the increased magnification and 3-dimensional vision allows for increased precision during complex reconstructive laparoscopic procedures such as pyeloplasty. Sometimes the narrowing at the ureteropelvic junction is related to an overlying blood vessel which can compress the tube externally and contribute to the obstructive process. The enhanced magnification provided by the laparoscopic or robotic technique allows for more accurate identification of these ‘crossing vessels’, which can then be moved away from the reconstructed ureteropelvic junction to prevent further obstruction. A ureteral stent (tube extending from the kidney to the bladder which provides drainage to the kidney and acts as a splint) is then placed to allow the repaired area to heal adequately. The average hospital stay for this procedure is usually 2-3 days with minimal postoperative discomfort, early recovery and minimal scar as compared to traditional open surgery. The ureteral stent is removed after 6 weeks, followed by a renal scan to confirm the success of the operation.

The University of Cincinnati Urology Division is one of the leading urology programs, not just in Cincinnati, but in the U.S. UC Urology provides quality health care using the most advanced technology and state-of-the-art diagnostic treatments. Many of our urologists are recognized in multiple national and local "Best Doctors" and "Top Doctors" listings. We provide minimally invasive surgical treatments which include laparoscopic, robot-assisted laparoscopic and endourologic procedures as well as comprehensive care for all urologic conditions.