Urine produced in the kidney is excreted to renal pelvis which a tunnel is shaped organ connected to ureter through pelvi-ureteric junction. Due to congenital abnormalities, damages caused in a previous surgery or other reasons the flow of urine from pelvi-ureteric junction to urethra may be obstructed. This may lead to progressive deterioration and renal damage.
Preliminary diagnosis of the obstructed pelvi-ureteric junction is made by studying the symptoms and medical history of the patient. For confirming the diagnosis of ureteropelvic junction obstruction, the surgeon may ask for diagnostic tests like electrocardiogram, blood chemistry profile, complete blood count, blood coagulation profile etc.
Preparations for surgery
Drugs like aspirin, plavix, celebrex etc which can cause bleeding has to be avoided prior to one week of the scheduled date for surgery. The patient is not expected to eat or drink anything after the midnight of the previous day of the surgery.
Laparoscopic surgery is carried out under general anaesthesia. The surgery may take 3 to 4 hours for completion. Three small incisions of the size of 1 cm are made in the abdomen. Laparoscope which is an instrument with a camera and a light source on one end of a long tube and other instruments needed for the surgery are inserted through these incisions. Seeing the videos taken by the camera in a monitor placed before the surgeon in the operation theatre, the surgeon performs the surgery controlling the instruments for surgery remotely. In this surgery the narrow portion in the junction of renal pelvis and ureter is excised and after clearing the obstruction the end pieces are stitched and joined together. A stent will be placed in the ureter which will function as a drain for the urine to flow, till the corrected PUJ heals completely. After about one month it will be removed under anaesthesia
After the surgery
The patient can return home on the second or third day of the surgery. The patient will be able to return to normal routine work 2 to 4 weeks after the surgery. It will take several weeks to regain your ability to drive a vehicle. The removal of stent can be done as an outpatient service. After removing the stent antibiotics will be given for about 3 days. After about three months the patient will have to undergo a diuretic renogram which is intended to ascertain whether the obstruction is still present or not.