+91 7704033027
+91 522 2732020
At Precision Urology centre of excellence for laparoscopic Urology, more and more complex reconstruction of parts of the urinary tract are done laparoscopically. The most challenging and crucial part of laparoscopic reconstructive procedures is intracorporeal suturing and knotting. Reconstructive surgery includes procedures like Pyeloplasty, ureterocystoneostomy, uretero-ureterostomy, bladder boari flap reconstruction.
Laparoscopic pyeloplasty is a way to perform reconstructive surgery of a narrowing or scarring where the ureter (the tube that drains urine from the kidney to the bladder) attaches to the kidney through a minimally invasive procedure. This operation is used to correct a blockage or narrowing of the ureter where it leaves the kidney. This abnormality is called a ureteropelvic junction (UPJ) obstruction which results in poor and sluggish drainage of urine from the kidney.
Laparoscopic pyeloplasty is performed under general anesthesia. The typical length of the operation is one to two hours. The surgery is performed through three small ( 5 mm to1 cm) incisions made in the abdomen. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to repair the blockage/narrowing without having to place his or her hands into the abdomen.
At the end of the procedure, a small drain will be left exiting your flank to drain away any fluid around the kidney and pyeloplasty repair and a Foley catheter to drain the urinary bladder. The drain is removed on 2nd post operative day while catheter is removed at 4th post operative day. Patient is usually discharged on 5th post operative day.
A small plastic tube (called a ureteral stent) is left inside the ureter at the end of the procedure to bridge the pyeloplasty repair and help drain the kidney. This stent remains in place for four weeks before it is removed as out patient procedure.
The patient is followed for post operative symptoms and ultrasonography for kidney swelling. If the results are fine, then post operative imaging is not required. Patient is considered cured at 3 months post operative follow up.
There are some benign conditions where a small segment of the pipe ( ureter) joining kidney and bladder is diseased such as permanent blockage due to long standing stone, iatrogenic injury to ureter, tuberculosis affecting ureter. In such cases the diseased pipe is removed and the continuity maintained. This procedure is called ureteo- ureterostomy. This can be done laparoscopically with all the advantages of minimally invasive surgery like less blood loss, less pain, less analgesic requirement and early post operative recovery. The essentials of the procedure and post operative management is similar to laparoscopic pyeloplasty.
What is Ureterocystostomy?
An operation whereby a ureter is implanted into the bladder.
What is a boari flap?
A Boari bladder flap is one of the options for ureteric reimplantation when the diseased ureteric segment is long (e.g. more than 5 cm). It is useful in the management of lower ureteric strictures and can be performed as either an open or laparoscopic procedure. It involves tubularisation of a flap of bladder to extend from the bladder to the ureteral orifice.
During both of these operations, your doctor removes scar tissue and may surgically reconstruct the lower ureter in a different location and reconnect it to the bladder. The procedure is done under General Anesthesia. 3-4 ports are placed, 10 mm at belly button and rest 5 mm ports on either side of lower belly. A telescope and small instruments are inserted into the abdomen through these keyhole incisions, which allow the surgeon to repair the blockage/narrowing without having to place his or her hands into the abdomen.
At the end of the procedure, a small drain will be left exiting your flank to drain away any fluid around the bladder and a Foley catheter to drain the bladder. This approach often results in less bleeding, less scarring, fewer wound infections, and less postoperative pain than conventional surgery. It can also lead to a shorter recovery time in the hospital. The drain is removed on 2nd post operative day while catheter is removed at 4th or 5th post operative day. Patient is usually discharged on 3rd-5th post operative day.