Robotic Pyeloplasty
Robotic Surgery for PUJ Obstruction
Robotic pyeloplasty is a minimally invasive operation used to correct a blockage or narrowing where the kidney joins the ureter, the tube that carries urine from the kidney to the bladder.
This area is known as the pelvi-ureteric junction (PUJ), or ureteropelvic junction (UPJ). If it becomes narrowed or obstructed, urine may not drain freely from the kidney. This can cause pain, infection and swelling of the kidney, known as hydronephrosis.
Mr Neil Oakley's specialist robotic practice includes robotic pyeloplasty and kidney reconstruction for appropriate patients. Consultation and assessment are available in Sheffield for patients from South Yorkshire and surrounding areas, with robotic surgery undertaken in Manchester.
What Is PUJ Obstruction?
Urine produced by the kidney collects within the renal pelvis before passing through the ureter towards the bladder.
The point where the renal pelvis joins the ureter is called the pelvi-ureteric junction.
A PUJ obstruction occurs when urine cannot drain freely through this junction. This may be caused by a narrowing within the junction itself or, in some patients, by the relationship between the ureter and a nearby blood vessel.
When drainage is restricted, urine can accumulate within the kidney and cause the renal pelvis and collecting system to become enlarged. This is known as hydronephrosis.
What Causes PUJ Obstruction?
PUJ obstruction can occur for different reasons.
In some patients, the narrowing has been present since birth but does not cause significant symptoms until later in life. In others, the obstruction may be associated with the anatomy of the blood vessels around the kidney.
Possible causes can include:
- A narrowing of the pelvi-ureteric junction
- Abnormal development of the junction
- A crossing blood vessel affecting drainage from the kidney
- Scarring or changes following previous surgery or treatment
- Other less common causes of obstruction
Identifying the nature of the obstruction and its effect on kidney drainage is an important part of deciding whether treatment is required.
What Are the Symptoms of PUJ Obstruction?
The symptoms of PUJ obstruction vary considerably between patients.
Some people have relatively few symptoms and the problem is discovered when a scan is performed for another reason. Others experience recurrent or significant symptoms.
These can include:
- Pain in the side or back around the affected kidney
- Intermittent episodes of kidney pain
- Pain that becomes more noticeable after drinking larger amounts of fluid
- Recurrent urinary infections
- Nausea or vomiting during episodes of pain
- Kidney stones in some patients
- Hydronephrosis identified on an ultrasound or other scan
- Reduced function of the affected kidney in more significant cases
These symptoms can have several possible causes, so appropriate investigation is required before attributing them to a PUJ obstruction.
How Is PUJ Obstruction Diagnosed?
Investigation aims to establish whether there is an obstruction, understand the anatomy of the kidney and ureter, and assess how effectively the affected kidney is functioning and draining.
Investigations may include:
- Ultrasound scanning of the kidneys
- CT scanning
- Other specialised imaging where appropriate
- Blood tests to assess kidney function
- Urine tests
- A renogram or nuclear medicine kidney scan to assess drainage and relative kidney function
A renogram can be particularly useful because it provides information about how well each kidney is functioning and how effectively urine drains from the affected kidney.
The results can help determine whether the narrowing is causing significant obstruction and whether surgical treatment should be considered.
Does Every PUJ Obstruction Need Surgery?
Not every patient with hydronephrosis or a suspected PUJ obstruction requires an operation.
If the kidney is functioning well, drainage is satisfactory and symptoms are limited, monitoring may be appropriate in some circumstances.
Surgery may be considered where there is evidence that the obstruction is causing significant problems, such as:
- Persistent or recurrent kidney pain
- Significant obstruction to urinary drainage
- Deterioration in the function of the affected kidney
- Recurrent urinary infections
- Kidney stones associated with poor drainage
- Other complications related to the obstruction
The decision to proceed with surgery depends on the patient's symptoms, investigations, kidney function and individual circumstances.
What Is a Pyeloplasty?
A pyeloplasty is an operation designed to reconstruct the connection between the kidney and ureter so that urine can drain more freely.
Rather than simply widening the narrowed area, the obstructed section is usually removed and the healthy ureter is reconnected to the renal pelvis to create a new, wider junction.
If a crossing blood vessel is contributing to the obstruction, the reconstruction can be planned so that the new junction is positioned appropriately in relation to the vessel.
The objective is to provide effective drainage from the kidney while preserving the kidney and its function.
How Is Robotic Pyeloplasty Performed?
Robotic pyeloplasty is performed under general anaesthetic using a minimally invasive or ‘keyhole’ approach.
A camera and robotic surgical instruments are introduced through several small incisions in the abdomen.
The kidney, renal pelvis and upper ureter are carefully identified. The surgeon locates the area of obstruction and assesses the surrounding anatomy, including any blood vessels that may be contributing to the problem.
The narrowed section is removed and the healthy ureter is reconstructed and joined to the renal pelvis to create a new drainage pathway.
A temporary internal ureteric stent is commonly placed across the reconstructed junction to support drainage while the tissues heal.
What Is a Ureteric Stent?
A ureteric stent is a thin, flexible tube positioned inside the ureter between the kidney and bladder.
Following pyeloplasty, the stent helps urine drain through the reconstructed junction while healing takes place.
The stent is temporary and is removed after an appropriate period of recovery. The timing and method of removal will be explained as part of your treatment pathway.
Some patients experience temporary urinary symptoms while a stent is in place, such as increased frequency of urination, urgency, bladder discomfort or discomfort around the kidney. These symptoms usually resolve after the stent is removed.
Why Use Robotic Surgery for Pyeloplasty?
Pyeloplasty is a reconstructive operation requiring careful dissection and precise suturing around the kidney and ureter.
The da Vinci robotic surgical system provides a magnified three-dimensional view of the operating area together with articulated surgical instruments controlled by the surgeon.
This can be particularly useful during reconstructive surgery where the narrowed junction needs to be removed and the ureter precisely reconnected to the renal pelvis.
Potential advantages of a minimally invasive robotic approach compared with traditional open surgery can include:
- Smaller surgical incisions
- Reduced post-operative discomfort for many patients
- Earlier mobilisation following surgery
- A shorter recovery period for many patients
- Detailed magnified visualisation of the kidney, ureter and surrounding anatomy
- Controlled movement during precise reconstructive suturing
Individual outcomes vary and the most appropriate surgical approach depends on the patient's anatomy, previous treatment and individual circumstances.
Find out more about Robotic Urological Surgery
What Are the Risks of Robotic Pyeloplasty?
Robotic pyeloplasty is a major surgical procedure and has potential risks and complications. These will be discussed before surgery as part of the consent process.
Potential risks can include:
- Bleeding
- Infection
- Urinary infection
- Urine leakage from the reconstructed junction
- Discomfort or urinary symptoms associated with the ureteric stent
- Injury to surrounding organs, tissues or blood vessels
- Persistent or recurrent narrowing of the PUJ
- The need for additional treatment or further surgery
There are also risks associated with general anaesthesia and abdominal surgery.
Your individual risks will depend on factors including your general health, kidney function, anatomy and whether you have undergone previous surgery or treatment in the area.
Recovery After Robotic Pyeloplasty
Recovery varies between patients, but mobilisation is encouraged following surgery and activity is gradually increased as healing progresses.
Some abdominal discomfort and tiredness are expected during the early recovery period.
Before leaving hospital, you will receive individual advice about:
- Pain relief
- Looking after the surgical wounds
- Managing any urinary symptoms associated with the stent
- Walking and general activity
- Driving
- Heavy lifting and exercise
- Returning to work
- Arrangements for removal of the ureteric stent
The time required to return to normal activities depends on your individual recovery and the physical demands of your work and lifestyle.
Follow-Up After Pyeloplasty
Follow-up is important to assess recovery and confirm that the reconstructed junction is allowing the kidney to drain appropriately.
The temporary ureteric stent will be removed after the initial healing period.
Further assessment may include imaging or a functional kidney scan to evaluate drainage from the kidney and compare it with the findings before surgery.
The precise follow-up pathway will depend on the reason for surgery, kidney function and your individual circumstances.
Robotic Pyeloplasty for Sheffield Patients
Patients from Sheffield, South Yorkshire and surrounding areas who have been diagnosed with PUJ obstruction or hydronephrosis can arrange a private consultation with Mr Oakley in Sheffield.
Your scans and other investigations can be reviewed to assess the cause and significance of the obstruction, the function of the affected kidney and whether reconstructive surgery may be appropriate.
If you decide to proceed with robotic pyeloplasty, appropriate consultation and pre-operative assessment can take place locally in Sheffield, with robotic kidney reconstruction performed by Mr Oakley in Manchester using the da Vinci robotic surgical system.
Private Urology Consultations in Sheffield
Robotic Surgery for Sheffield Patients
Diagnosed with PUJ Obstruction?
If you have been diagnosed with PUJ obstruction, hydronephrosis or impaired drainage from the kidney and would like to discuss whether robotic pyeloplasty may be appropriate, you can arrange a private consultation with Mr Neil Oakley in Sheffield.