Arthur Smith Institute for Urology, New Hyde Park, NY :: 516.734.8500

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Kidney & Ureteral Stones

Treatment

Several options exist for patients with ureteropelvic junction obstruction, or blockage of the ureter at the point where it connects with the kidney.

Observation

In older patients if there is good function in the opposite kidney and no symptoms, observation may be an option. Also if there is poor function in the obstructed kidney surgery will not usually improve function and it is reasonable to defer treatment. In younger individuals watching and following the kidney function with repeated X-ray studies is an option if there is excellent function and no symptoms. However, if one elects this approach frequent followup is needed to allow early recognition and repair to preserve future kidney function. One may lose total function in a kidney within 6 months.

Surgery

Surgical correction of the kidney blockage improves urine flow, removes the obstruction, improves symptoms and reduces the risk for further kidney damage. The exact surgical approcach depends upon the cause of obstruction and the experience of the surgeon. In experienced hands, both children and adults can be treated with less-invasive procedures. Regardless of approach, in most cases a temporary tube called a stent may be placed to drain urine from the kidney. Depending upon the approach the stent is removed in 3 to 6 weeks following surgery. This removal can usually be done in the office.

Pyeloplasty

Pyeloplasty is a procedure where the ureter is surgically repaired. The area of blockage is excised or reconfigured to allow free flow of urine from the kidney. This can be performed equally with an open or laparoscopic approach.

• Open Pyeloplasty is performed through a flank incision using standard open techniques.
• Laparoscopic Pyeloplasty is performed through 3 small incisions (1/4 inch) in the abdomen. The surgery is carried out under the vision of a small telescope. This approach has the same success rate as open surgery, but offers quicker convalescence, less pain and a better cosmetic result.

Endopyelotomy

Endopyelotomy is a technique where the ureter is cut from the inside to open the area of blockage. Success of this technique depends upon several factors. It is usually more effective in instances of good kidney function, minimal hydronephrosis and absence of a crossing blood vessel. It can also be effective in patients who have failed prior surgery. This procedure can be performed as an outpatient or overnight stay. The success rate with these approaches is not as good as pyeloplasty and patients must have a stent for 6 weeks. This is a plastic tube in the ureter that goes from the kidney to the bladder. Endopyelotomy can be performed in 3 manners:

• Percutaneous endopyelotomy treats the obstruction through a single small, 1/4 inch) incision in the back. A telescope is assed through this incision into the kidney and a knife or laser is used to cut the ureter. Occasionally a suture is placed at the time of incision to aid in the repair (endopyeloplasty). With this approach, a nephrostomy tube (a plastic tube placed in the patient's side to drain urine) may also be temporarily required after surgery.
• Ureteroscopic endopyelotomy corrects the obstruction by passing a small telescope through the water channel, the urethra.
• Accucise endopyelotomy addresses the blockage by passing a balloon with a wire up the ureter using X-ray guidance. The wire is electric and when activated cuts the ureter.