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

Urologic Surgery Using The da Vinci Surgery System
The da Vinci Surgical System translates the surgeons movements precisely using a smaller opening

When working near delicate and sensitive parts of the body, robotic surgery offers improved outcomes by enhancing the capabilities of the surgeon. The robot is controlled entirely by the surgeon, replicating his or her delicate maneuvers precisely. Smaller incisions are needed with robotic surgery than traditional surgery, while the surgeon can also assess the surrounding areas and lymph nodes for signs of cancer spread (metastasis). Using a small camera, the surgeon views high resolution images on a video screen at the control console.

Benefits of robotic surgery include:

  • Improved functional recovery
  • Highly delicate repairs can be made
  • Shortened physical recovery time

After the cancerous area or organ has been removed, the robot is also used to repair areas of the body to restore function. They may use tissue from the bladder, or bowel, for example, to repair the ureter—small tubes that carry urine from the kidneys to the bladder. The robot is so precise that the surgeon can stitch very small tissues together. These maneuvers take place in a very small space which helps reduce patient recovery time. To help the ureter heal, a small flexible tube may be placed in the ureter to ensure it repairs open while it is healing. The tube will remain in place 4 to 6 weeks. You doctor will share additional information and care instructions before and after surgery, which will be essential to maximize patient recovery.

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 in life 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 stay 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 Indiana pouch. Providence Saint John’s specializes in this procedure.

Urologic Cancer Supportive Care

In addition to the expert medical care available from our team of cancer physicians, we offer a host of integrative and wellness services that aim to address the physical, emotional, social, mental, and spiritual needs of patients and their loved ones throughout the cancer journey.