Pyeloplasty is the surgical reconstruction of the renal pelvis (a part of the kidney) to drain and decompress the kidney. In nearly all cases, the goal of the surgery is to relieve a uretero-pelvic junction (UPJ) obstruction.
Pyeloplasty is done to clear a blockage where the renal pelvis connects with the ureter, the tube that carries urine from the kidneys to the bladder. This narrowing causes dilation of the kidney, a condition called hydronephrosis. Hydronephrosis can usually be verified with an ultrasound and kidney scan. The original ureter is surgically approached below the level of the obstruction and the abnormal section is removed. Then the ureter is repositioned and reattached to the healthy renal pelvic tissue above.
The surgery can be done from a few different angles. In general, the incision will be on your child's side. Your surgeon will discuss the location of the incision that is most appropriate for your child. All the surgical stitches, called sutures, will dissolve. Occasionally, one skin suture is removed 10 days or so after the operation if a tube is inserted.
Surgeons use different approaches. In some cases, no tubes are left in place. In other cases, a tube called a "stent" may be left for seven to 10 days to drain the ureter, or a kidney catheter tube called a nephrostomy may remain for 10 to 12 days. A small drain made of special soft rubber, called a Penrose drain, may be left under the incision. The tube or drains are removed in the office. Removal causes minimal, brief discomfort, although it may feel strange.
Occasionally, a small amount of reddish-brown drainage comes out of the tubes or drains. The skin around the tubes may redden and have pus-like secretions. This is a natural reaction to the drain and nothing to be alarmed about. Before you take your child home, we will help you get comfortable assessing and caring for the tube.
While in the hospital, your child will have a catheter in his or her bladder to assure that the bladder and kidney aren't stressed. Your child may experience bladder spasms or intermittent cramping. A medication called Ditropan will provide relief. The catheter will be removed before your child goes home.
The surgery takes about two to three hours.