Robot-assisted pyeloplasty uses the Da Vinci surgical system to enable the surgeon to operate by controlling a series of robotic arms through small incisions to correct ureteropelvic junction obstruction.
The underlying abnormality causing the UPJ obstruction is corrected by detaching the ureter from the kidney, removing the narrowed segment, rerouting the ureter over the obstructing crossing blood vessel, and reattaching the ureter. Robot-assisted procedures enable dramatically faster recovery than traditional open surgery.
When to Ask a Urologist about Robot-Assisted Pyeloplasty
You should speak with a Urologist about Robot-Assisted Pyeloplasty if you have been diagnosed with UPJ obstruction.
Cost
Typically covered by most insurances (although coinsurance and deductibles may apply). Coverage will be verified prior to proceeding. If you do not have insurance, our office will be able to give you an out-of-pocket cost estimate.
Effectiveness
Pyeloplasty success rates are very high, around 95%.
Possible Side Effects
The risks associated with pyeloplasty include bleeding, infection, damage to adjacent structures, urine leak, recurrent or worsening obstruction as well as the risks of major abdominal surgery with general anesthesia, such as hernia, stroke, heart attack, blood clot, and a very small (<1%) possibility of death.
Alternative Approaches
Alternatives to pyeloplasty include observation without treatment, surgical removal of the entire kidney, chronic indwelling ureteral stent, traditional open pyeloplasty, and endopyelotomy with instruments passed up the ureter to incise or balloon dilate the narrowed portion.
What to do to Prepare for Surgery
You will receive detailed instructions from the surgical schedulers regarding any necessary testing or appointments prior to surgery. In general, you should temporarily stop blood-thinning medications prior to surgery (when to stop depends on the type of blood thinner). Prescription blood-thinning medications should be stopped following clearance from the doctors that prescribed them though other medications that thin the blood including fish oil and pain relievers such as ibuprofen should be stopped as well.
On the day before surgery, you will receive a phone call alerting you to the time that you should arrive, and you should wash the surgical area with an antibacterial soap. You may be instructed to drink one bottle of magnesium citrate to evacuate the bowels in preparation for the procedure.
You should not eat or drink anything after midnight on the day of surgery, but you may take approved home medications in the morning before surgery with a small sip of water.
What to Expect after Surgery
The surgery typically requires hospitalization for about two nights. Patients have a catheter draining their bladder that is usually removed prior to discharge unless a segment of bladder had to be removed with the kidney. An additional external surgical drain will also be placed during surgery and removed prior to discharge.
The urine is usually tinged with blood. Light activity, including walking, under nursing supervision is recommended. The nursing staff will also provide teaching to use a breathing device called an incentive spirometer that helps encourage patients to take deep breaths. Patients may begin drinking liquids following surgery and can slowly advance to more solid food as tolerated. It is common to have abdominal discomfort and bloating.
A temporary internal stent between the kidney and bladder is placed at the time of surgery to help with healing. In some patients, this stent may lead to frequency and urgency of urination, blood in the urine, and flank discomfort. The internal stent is removed in the office during a follow-up visit around 6 weeks after surgery.