The goals in treating patients with Ureteropelvic Junction (UPJ) obstruction are to improve renal drainage and to maintain or improve renal function.
Surgical Treatment:
Endopyelotomy,
Open pyeloplasty
Laparoscopic pyeloplasty
Robotic-assisted laparoscopic pyeloplasty.
The principles of surgical repair:
Formation of a funnel
Dependent drainage
Watertight anastomosis
Tension-free anastom
Types of pyeloplasty
Anderson-Hynes dismembered pyeloplasty
Foley Y-V plasty
Culp and DeWeerd
Scardino and Prince
Endopyelotomy
1. The stricture should be short (< 1.5 cm), and no crossing vessels should be defined on imaging
2. An endopyelotomy incision is performed through the area of obstruction with a laser, electrocautery, or endoscopic scalpel.
3. This is followed by prolonged ureteral stenting, for a period of 4-8 weeks.
4. When open pyeloplasty fails, endopyelotomy is particularly useful
Laparoscopic pyeloplasty
This procedure is replacing open pyeloplasty as the criterion standard with 95% success rates.Significant learning curve associated with laparoscopic suturing
Complications:
Complications from open surgical pyeloplasty include UTI and pyelonephritis,urinary extravasation and leakage, recurrent ureteropelvic junction (UPJ) obstruction, or stricture formation.
Surgical Treatment:
Endopyelotomy,
Open pyeloplasty
Laparoscopic pyeloplasty
Robotic-assisted laparoscopic pyeloplasty.
The principles of surgical repair:
Formation of a funnel
Dependent drainage
Watertight anastomosis
Tension-free anastom
Types of pyeloplasty
Anderson-Hynes dismembered pyeloplasty
Foley Y-V plasty
Culp and DeWeerd
Scardino and Prince
Endopyelotomy
1. The stricture should be short (< 1.5 cm), and no crossing vessels should be defined on imaging
2. An endopyelotomy incision is performed through the area of obstruction with a laser, electrocautery, or endoscopic scalpel.
3. This is followed by prolonged ureteral stenting, for a period of 4-8 weeks.
4. When open pyeloplasty fails, endopyelotomy is particularly useful
Laparoscopic pyeloplasty
This procedure is replacing open pyeloplasty as the criterion standard with 95% success rates.Significant learning curve associated with laparoscopic suturing
Complications:
Complications from open surgical pyeloplasty include UTI and pyelonephritis,urinary extravasation and leakage, recurrent ureteropelvic junction (UPJ) obstruction, or stricture formation.
