Repair of Ureteral Strictures – Ureteroplasty

The ureters are the tubes that carry urine from the kidneys to the bladder. There are several reasons scar tissue may form in a ureter especially after trauma, operative injury to ureter or even radiation. Some times the ureter may be narrow from other medical issues like endometriosis or cancer. Scar tissue makes the ureter tube narrow and the urine does not drain well. This is painful and leads to infection or worse long term kidney damage. Ureteroplasty is a procedure and surgery that can fix the narrowing.

Surgery

The surgery is usually done robotically. The scope is put through small incisions in the abdomen. The scope sends pictures from inside the abdomen to a video screen. Surgical instruments are placed through the other incisions. The surgeon uses a robotic consult to operate the surgical instruments in the abdomen. Specifically for this surgery, the narrowed part of the ureter tube is resected. Tissue from the bladder or bowel is used to repair the ureter.  Sometimes more simply the cut ends of the ureter are then stitched together. A long, flexible tube called a stent is put into the ureter and runs from the ureter to the bladder. It will remain in the ureter for 4 -6 weeks to help hold the ureter open while it is healing. Sometimes a small drain in the belly is also bladder and come out one the holes that the surgeon used to enter the abdomen.

After Surgery

Patients stay in the hospital 1-2 days with a catheter in your urethra and drain. The catheter and the drain are removed prior to discharge. Pain control will be provided if the patient is uncomfortable.

Treatment Of UPJ Obstruction: Robotic Pyleoplasty

Pyeloplasty has the best success for patients with UPJ obstruction. After laparoscopic pyeloplasty, there may be scarring in the abdomen area. Typically, the obstruction will not come back but that is possible.

UPJ obstruction can be treated with surgery called a pyleoplasty. Sometimes this is treated very early inlife to prevent failure or injury of the kidney.  Surgery is not required for all patients. Surgery is usually minimally invasive and is known as pyeloplasty. The process takes a few hour. The portion of the ureter that is scarred or blocked by a another vascular structure is removed or repaired. The normal ureter is then reattached to the renal pelvis of the kidney. A stent is left in the ureter until the repair is healed, usually 2-4 weeks.

What happens after pyeloplasty surgery?

  • Patients will stays overnight for 1-2 days
  • The ureter is swollen and this may cause some discomfort.
  • The stent is removed in 2-4 weeks in the clinic during a procedure called a cystoscopy. The doctor will place a small flexible camera into the bladder through the urethra and remove the stent.

Risks for patients after surgery could be urinary tract infections or kidney stones.

Reconstruction after Cystectomy

Urinary Reconstruction and Diversion

When bladder cancer forces the removal of the entire bladder, the surgeon creates another way for urine to be collected, stored and released from the body.

There are three ways this can be done and our physicians will help you decide which is best for you:

Artificial bladder

A surgeon uses tissues from the intestines to create what is known as a neobladder. The neobladder is attached to the urethra and allows the patient to urinate normally. We are leaders in the field of this minimally invasive laparoscopic surgery. With this procedure, there is less blood loss and patients are able to return to normal physical activity much faster.

Urinary diversion with a bag outside the body

A surgeon uses intestinal tissue to create a path for urine to leave the body through an opening in the abdomen. This path is called a stoma. Its opening in the abdomen is covered by a bag that sits outside the body and catches the urine as it is released.

Urinary diversion with a pouch inside the body

A surgeon uses intestinal tissue to create a reservoir called an Indiana Pouch and a path that leads out to the abdomen. The pouch collects urine inside the body. Several times a day, the patient uses a catheter, or soft tube, to connect to the path in the abdomen and empty urine in the pouch.