A ureteropelvic junction (UPJ) obstruction refers to a blockage in the upper half of one or more of your ureters, the tubes that carry urine from the kidney to your bladder. Usually, UPJ obstruction is present at birth and may clear on its own. However, adults can develop UPJ obstruction after:
A UPJ obstruction is extremely painful and potentially dangerous. Untreated, it could lead to nephrosis (i.e., swollen kidneys), kidney damage, or even kidney failure.
Expert urologist, Alex Lesani, MD, corrects UPJ obstruction with a minimally invasive procedure called robotic pyeloplasty. He evaluates whether you’re a candidate for pyeloplasty at our Las Vegas, Nevada, office.
Do you have UPJ obstruction? Here’s how robotic pyeloplasty can restore your flow, with less trauma and recovery time, compared with conventional open surgery.
Pyeloplasty is a type of surgery that removes or corrects the blockage in the UPJ so that urine flows freely from your kidney through your ureters and into your bladder. Like traditional open surgery, robotic pyeloplasty is considered major surgery and requires hospitalization and general anesthesia. You need to arrange for somebody else to transport you home.
We also give you pre-operative instructions, such as quitting smoking, discontinuing substances that thin your blood, and fasting before your operation. You also need to make arrangements for postoperative care while you’re healing. You won’t be able to do housework or go to your job for 3-4 weeks, in most cases.
At the hospital, you change into a gown, and we wheel you into the operating room. We then administer anesthesia that keeps you safe, comfortable, and unconscious during the surgery. We also place a catheter to drain urine. We fill your abdomen with carbon dioxide gas.
After we disinfect the operative area, we only need to make 4-5 incisions about 1 cm long each. Through these, we thread the various robotic arms. This is a stark contrast to open surgery, which requires a large incision that’s then held open. The robotic surgery inflicts less trauma and has less blood loss.
Dr. Lesani sits at a console, where he operates the robotic arms that manipulate miniature scalpels and other tools, as well as the camera that allows him to visualize the operating field. The multi-jointed robotic arms enable Dr. Lesani to make precise, fine movements for minimal trauma and maximum efficiency.
Dr. Lesani controls every movement of the robotic arms and watches the procedure, magnified, in 3D, and in full-color high-definition on his console. The miniature instruments are much tinier than a human hand could hold. These tiny “hands” are also able to operate inside your body.
With such precision at his fingertips, Dr. Lesani removes any scar tissue or damaged section of the UPJ. He can also remove any kidney stones that may be currently present with a separate tool. If a crossed vessel has contributed to your UPJ obstruction, Dr. Lesani places it in the correct position to alleviate pressure on the UPJ.
Once he’s dissected and is ready to reconnect the ureter, he opens up each end slightly to create a flat area, a procedure called spatulation. He then attaches the two spatulated ends, which creates a slightly larger area for urine to pass through at the juncture.
He also places a small stent so that your urine can drain through the stent while your ureter heals over the next 3-4 weeks. He may also place a surgical drain, which he removes within 48 hours. The entire procedure takes 2-3 hours.
You have pain for a few days after your surgery, which is managed in the hospital with intravenous medication or a pump that you control. After discharge, you may need to eat a modified, soft diet. You must also drink small amounts at a time, allowing your body to recover.
We also get you up and moving as soon as possible. This helps prevent blood clots. We also have you cough or breathe out into a tube to help remove anesthesia from your system. You may experience constipation, gas, or cramps due to the operation and the carbon dioxide. You generally only stay for one day in the hospital.
After recovery from your pyeloplasty, we remove the stent, and your urine flows freely again, on its own. Dr. Lesani may recommend lifestyle changes to minimize the risk of kidney stones and to optimize your overall health.
To schedule an evaluation for robotic pyeloplasty for UPJ obstruction, phone our office at 702-470-2579 or choose a date by booking your appointment online.
