Laparoscopic repair of obstructed kidney-A A +A
Monday, August 26, 2013
MANY abnormalities arise in our kidneys, and the most common of these is the ureteropelvic junction (UPJ) stenosis.
The ureteropelvic junction is the area of the kidney where the funnel like area of the kidney called renal pelvis joins the tube of the kidney called the ureter.
A stenosis is a narrowing of a tubular structure causing obstruction.
In UPJ stenosis, the flow of urine from the kidney is impaired due to the obstructed segment causing the renal pelvis to balloon and sometimes lead to destruction of the kidney tissue in long standing obstruction.
Other complications include formation of kidney stones, blood in the urine and recurrent urinary tract infection.
In cases like these, it is important to request for laboratory tests such as the serum creatinine to assess the renal function and a urinalysis to note presence of urinary infection.
Then imaging tests are also imperative and the first line imaging modality is an ultrasound of the kidneys, ureters and bladder which would show the ballooned out area. Then further tests are warranted to investigate further the degree of obstruction as well as to assess the renal function.
Contrast imaging is the next step, either an intravenous pyelogram or a CT urogram. Once these are done, planning for the mode of management is done.
A UPJ stenosis is an anatomic abnormality which has to be repaired surgically and the gold standard of treatment is doing a procedure called a dismembered pyeloplasty.
This is done by cutting the narrowed segment in the ureter, trimming the renal pelvis if necessary and then connecting the normal caliber ureter to the renal pelvis by using absorbable sutures (stitches).
It is also important to mention that this repair should be done tension free and with the use of tube called a stent in the ureter with one end in the renal pelvis and the other end in the urinary bladder.
A tension free repair is achieved by adequate mobilization of the ureter. The stent ensures minimally leakage of urine from the repair as well as minimizes narrowing of the ureteral caliber due to scarring. A dismembered pyeloplasty can be done by different approaches such as the traditional open surgery, laparoscopically and by robotic surgery.
The traditional open surgery is done with an incision in the flank. This procedure has been has been the cornerstone in the management of such abnormalities, however, the trend in most surgical specialties is geared towards minimally invasive procedures.
Hence, the open surgeries is slowly being replaced either by laparoscopy or even robotic surgery. In laparoscopic surgery, only small incisions are made as well as in robotic surgery.
The advantage of the minimally invasive surgical procedures is that there will be a shorter hospital stay for the patient, faster recovery and earlier resumption of their usual activities.
Last August 10, a laparoscopic dismembered pyeloplasty was done at Davao Medical School Foundation (DMSF) Hospital, the very first of such done in Mindanao. This was performed by a team of urologists trained in the National Kidney and Transplant Institute (NKTI), namely Dr. Michael Jonathan Latayan, who is based in DMSF Hospital and Dr. Hermenegildo Zialcita who is based in NKTI.
The procedure went smoothly. The post operative course was unremarkable and the patient went home on the fourth hospital day.
The equipment, instruments and expertise is now available in our locality and the option of a minimally invasive approach for several kidney problems can now be offered to our patients.
Published in the Sun.Star Davao newspaper on August 27, 2013.