Pelvi-Ureteric Junction Obstruction (PUJ or UPJ) & Robotic Assisted Pyeloplasty
Robotic Assisted Pyeloplasty & Pelvi-Ureteric Junction (PUJ) Obstruction
What is a PUJ Obstruction?
A Pelvi-Ureteric Junction Obstruction is the most common congenital abnormality of the ureter and causes a blockage of the drainage system of the kidney where it joins the tube called the ureter, which drains urine to the bladder. The blockage can lead to pain, urinary infections, kidney stones and high blood pressure and so should be treated as soon as possible. It affects both kidneys in 10% of patients. Modern series would suggest that in about 50% of patients the blockage is caused by a narrowing in the ureter and the remaining by a kinking of the ureter over an extra blood vessel or indeed vessels supplying the lower part of the kidney.
The most successful treatment for PUJ obstruction is reconstructive surgery, a pyeloplasty, where surgeons remove the blockage and reattach the healthy part of the kidney to the healthy part of the ureter.
Once only performed by open surgery, laparoscopic or keyhole surgery has been considered the gold standard. However, many kidney surgeons found this procedure to be technically challenging due to the difficulty in stitching, but with the hugely improved dexterity offered by the Da Vinci Robot it means faster, better, more accurate stitching is possible. The Da Vinci Robot now provides more people than ever before, with a reliable and minimally invasive repair of a pelvi-ureteric obstruction.
Robotic Assisted Pyeloplasty (RP)
A Pyeloplasty procedure should nearly always involve a formal dismemberment and reconstruction of the narrow segment of the pelvi-ureteric junction (PUJ) over a ureteric stent (a tube placed before or during, sitting between the kidney and the bladder). This stent helps to ensure a water tight anastamosis (join of the tubes). In up to 50% of cases where there is a kink around an extra vessel/ vessels, the join or anastamosis is performed on the other side of this vessel, rather than dividing the vessel or vessels.
We perform a pyeloplasty procedure through the back rather than the front of the abdomen. We believe this retro or extra peritoneal approach results in a more rapid discharge from hospital compared to an approach through the front as well as being more cosmetically more attractive with the 4 small incisions being round the back and therefore less visible. Patients are usually discharged the day following surgery and return 4 weeks later for removal of the stent, either under local anaesthetic or a very short general.
For more information on the pyeloplasty procedures performed by the Da Vinci Robotic System, please visit http://www.davincisurgery.com/da-vinci-urology/da_vinci_pyeloplasty.php