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Pyeloplasty is a type of surgical procedure performed to treat an uretero-pelvic junction obstruction if residual renal function is adequate. [1]This revision of the renal pelvis treats the obstruction by excising the stenotic area of the renal pelvis or uretero-pelvic junction and creating a more capacious conduit using the tissue of the remaining ureter and renal pelvis.
A partial nephrectomy should be attempted when there is a kidney tumor in a solitary kidney, when there are kidney tumors in both kidneys, or when removing the entire kidney could result in kidney failure and the need for dialysis. Partial nephrectomy is also the standard of care for nearly all patients with small renal masses (<4 cm in size). [22]
Risks during surgery include heart problems, pulmonary (lung) complications, development of blood clots , blocking of arteries , and injury to adjacent structures, such as bowel or vascular entities. Inadequate ureteral length may also be encountered, leading to ureteral kinking and subsequent obstruction.
A ureteral stent (pronounced you-REE-ter-ul), or ureteric stent, is a thin tube inserted into the ureter to prevent or treat obstruction of the urine flow from the kidney. The length of the stents used in adult patients varies between 24 and 30 cm. Additionally, stents come in differing diameters or gauges, to fit different size ureters.
Ureteroureterostomies are often performed because of injured or scarred ureters, especially when the ureter in question is damaged in its upper third section. [2] Generally if the patient has distal uretral strictures (narrowing of the ureter), [3] a ureteroureterostomy is not recommended and a ureter reimplantation would be favorable.
The donor kidney will be placed in the lower abdomen and its blood vessels connected to arteries and veins in the recipient's body. When this is complete, blood will be allowed to flow through the kidney again. The final step is connecting the ureter from the donor kidney to the bladder. In most cases, the kidney will soon start producing urine.
Transurethral surgery has been the cornerstone of endourology. Most of the urinary tract can be reached via the urethra, enabling prostate surgery, surgery of tumors of the urothelium, stone surgery, and simple urethral and ureteral procedures. Recently, the addition of laparoscopy and robotics has further subdivided this branch of urology.
If the ureters have been resited as a result of surgery, for example due to a kidney transplant or due to past surgery for vesicoureteric reflux, that site may also become narrowed. [15] [1] A narrowed ureter may lead to ureteric enlargement and cause swelling of the kidneys (hydronephrosis). [13]