Pyeloplasty
What is Pyeloplasty ?
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Why do you need Pyeloplasty ?
Pyeloplasty is indicated for:
- Ureteropelvic junction (UPJ) obstruction:
- Congenital (most common, 1 in 1,500 births; often diagnosed in children or prenatally via ultrasound).
- Acquired: Due to kidney stones (as in your ESWL/PCNL queries), scarring, or tumors (rare).
- Symptoms: Flank pain, recurrent UTIs, kidney stones, or hydronephrosis; can lead to kidney damage if untreated.
- Prevalence in India: 10–20% of prenatally diagnosed hydronephrosis cases need surgery.
- Associated conditions:
- Kidney stones (20–30% of UPJ cases; obstruction traps stones).
- Reduced kidney function (if chronic obstruction; 10–20% have significant impairment).
- Associated treatments:
- Pre-op: Stent or nephrostomy tube to relieve obstruction (if infection or severe hydronephrosis).
- Post-op: Double-J stent to ensure drainage during healing.
- Timing:
- Performed in children (often <5 years for congenital cases) or adults (20–40 years for acquired); urgency depends on symptoms and kidney function (e.g., immediate if infection or severe pain).
The procedure aims to relieve obstruction, preserve kidney function, and prevent complications like infections or kidney damage, often using minimally invasive techniques for faster recovery.
Why Do Pyeloplasty Costs Vary in Philippines?
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Pyeloplasty Procedure
- Before Surgery Evaluation:
- Assessment:
- Imaging: Ultrasound, CT, or MR urography to confirm UPJ obstruction and assess hydronephrosis severity.
- Diuretic renogram (MAG3 scan): Measures obstruction (T1/2 >20 minutes) and split kidney function.
- Blood tests: Kidney function (creatinine), blood sugar, clotting profile.
- Urine test: Checks for infection (UTI treated pre-op).
- Preparation: Stop blood thinners (e.g., aspirin) 5–7 days prior if safe; antibiotics if infection present.
- Consent: Risks, including urine leak, are explained.
- Assessment:
- Surgical Technique:
- Pyeloplasty:
- Performed under general anesthesia, lasting 2–4 hours.
- Types:
- Dismembered pyeloplasty (Anderson-Hynes): Most common; obstructed segment removed, ureter reattached to renal pelvis.
- Non-dismembered (e.g., Foley Y-V plasty): Less common; used for specific anatomies (e.g., high ureteral insertion).
- Approaches:
- Open pyeloplasty: Incision (10–15 cm) in flank; traditional method, often for children or complex cases.
- Laparoscopic pyeloplasty: 3–4 small incisions (5–10 mm); camera and instruments used; less invasive.
- Robotic-assisted (e.g., da Vinci): Similar to laparoscopic; enhances precision, common in adults.
- Process:
- Obstructed UPJ segment excised; crossing vessels (if present, 20–30% of cases) transposed.
- Renal pelvis and ureter reconstructed with fine sutures to create a wide, patent junction.
- Double-J stent placed (ureter to bladder) to ensure drainage during healing.
- Closure: Sutures for laparoscopic/robotic; sutures/staples for open; drain placed near kidney.
- Intraoperative Tools:
- Endoscope: Visualizes UPJ intra-op (if needed).
- Robotic system: Assists suturing in tight spaces.
- Fluoroscopy: Confirms stent placement.
- Pyeloplasty:
- After Surgery:
- Hospital stay: 2–4 days (laparoscopic/robotic); 4–6 days (open).
- Care: Drain removed in 1–2 days; Double-J stent removed in 4–6 weeks; hydrate well.
- Pain management: Moderate pain for 3–5 days; managed with painkillers (e.g., paracetamol).
- Instructions: Avoid strenuous activity for 4–6 weeks; monitor urine output and kidney function.
Recovery After Pyeloplasty
- Hospital Stay: 2–4 days (laparoscopic/robotic); 4–6 days (open).
- Post-Surgery Care:
- Pain: Moderate pain for 3–5 days (flank); resolves in 1–2 weeks.
- Urine: Mild hematuria for 3–5 days; clears with hydration; stent may cause mild discomfort (urgency).
- Activity: Avoid strenuous activity for 4–6 weeks; light activities in 1–2 weeks.
- Stent: Double-J stent removed in 4–6 weeks (outpatient procedure); may cause temporary irritation.
- Diet: Hydrate (2–3 liters/day); low-sodium diet to reduce kidney strain.
- Follow-Up:
- Visits at 1 week (check healing), 4–6 weeks (stent removal), and 3–6 months (assess outcome).
- Imaging: Ultrasound or renogram at 3 months to confirm resolution of obstruction (90–95% success rate).
Most resume normal activities in 2–3 weeks (laparoscopic) or 4–6 weeks (open); full recovery takes 6–8 weeks. Success rate: 90–95% resolution of obstruction; kidney function preserved or improved in 80–90% of cases.
Risks and Complications
- Surgical Risks:
- Bleeding (2–5%): During surgery; may need transfusion (1–2%).
- Infection (2–5%): At incision site or UTI; treated with antibiotics.
- Anesthesia risks (<1%): Reaction to anesthesia; rare in healthy patients.
- Post-Surgery:
- Urine leak (2–5%): From suture line; usually resolves with stent or nephrostomy tube.
- Stent issues (5–10%): Discomfort, migration, or blockage; may need repositioning.
- Recurrence of obstruction (5–10%): Scar tissue at repair site; may need endoscopic procedure or redo pyeloplasty.
- Injury to nearby organs (1–2%): Bowel, spleen (rare); may need repair.
- Long-Term:
- Kidney function decline (<1%): If chronic damage pre-op; monitor creatinine.
- Stone formation (10–20%): If underlying risk factors; needs dietary changes.
Report fever, severe pain, decreased urine output, or persistent hematuria promptly.
Frequently Asked Questions (FAQs)
What causes the need for pyeloplasty?
UPJ obstruction (congenital or acquired), often due to narrowing, crossing vessels, stones, or scarring.
Can I avoid pyeloplasty?
Yes, if mild: Observation for asymptomatic cases (children); endoscopic procedures (e.g., endopyelotomy) for select adults; pyeloplasty is gold standard for severe cases.
Is pyeloplasty painful?
Moderate pain for 3–5 days, managed with medication; resolves in 1–2 weeks.
How soon can I resume normal activities?
Light activities: 1–2 weeks; full recovery: 6–8 weeks; avoid strenuous activity for 4–6 weeks.
Is pyeloplasty covered by insurance in India?
Often covered (medical necessity); confirm with your provider; Ayushman Bharat often subsidizes.
Signs of complications?
Fever, severe pain, decreased urine output, or persistent hematuria.
Will my kidney function improve after surgery?
Usually: 80–90% see preserved or improved function if treated before significant damage; depends on pre-op status.
Lifestyle changes post-surgery?
Hydrate well, reduce salt intake, monitor for stones or infections, and attend follow-ups.
Conclusion
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Looking for Best Hospitals for Pyeloplasty
Note: we are not promoting any hospitals
We do not promote any hospitals. All details are sourced from Google and hospital websites. Please verify independently. Start with your surgery—here’s the list of government, budget, and superspecialty hospitals accredited by the Department of Health (DOH), Philippine Health Insurance Corporation (PhilHealth), and Joint Commission International (JCI)
- click on your city and schedule your surgery now done in good hands.
| City | Minimum Price (₱) | Maximum Price (₱) |
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Angeles City |
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Antipolo |
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Bacolod |
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Bacoor |
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Baguio |
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Butuan |
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Cagayan de Oro |
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Caloocan |
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Cebu City |
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Dasmariñas |
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Davao City |
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General Santos |
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General Trias |
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Iligan |
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Iloilo City |
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Las Piñas |
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Makati |
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Malolos |
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Manila |
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Muntinlupa |
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Parañaque |
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Pasay |
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Pasig |
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Puerto Princesa |
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Quezon City |
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San Fernando |
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San Jose del Monte |
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Taguig |
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Valenzuela |
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Zamboanga City |
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Disclaimer
This information is sourced from open platforms and is for general awareness only. Costs may vary based on individual cases. Please consult a qualified doctor for medical advice and explore options within your budget before deciding on the procedure.