Endopyelotomy

If PUJ is caused due to fibrous scarring in the kidneys by stones or birth defects or obstruction is caused by a blood vessel in the vicinity etc, endopyelotomy is the ideal method and is mostly adopted in case of adults. Prior to the surgery, the patient is advised to stop smoking and taking pain relieving drugs etc for at least 2 weeks so as to prevent healing problems that may occur.

Two methods are commonly used for Endopyelotomy; both these approaches are performed under general anesthesia.

Antegrade Endopyelotomy

The PUJ junction of the kidney is reached through the nephrostomy tube from the side. A nephrostomy is nothing but an artificial opening created between the skin and the kidney that facilitates urinary diversion from the renal pelvis. A nephrostomy tube is a small tube that is used to drain the kidney temporarily. The obstruction present in the PUJ is dissected or removed using a blade. The entire procedure lasts for about 2 – 3 hours. The nephrostomy tube is removed after two weeks.

Retrograde Endopyelotomy

Here the PUJ is approached via the urethra. The instrument consists of a balloon that dilates the infected area and simultaneously cuts so as to relieve the obstruction present.

After the surgery, the patient is kept under observation for 2 days to look for immediate post operative complications. All kinds of physical activity are to be avoided for a month. Excessive bleeding and injury to other organs are the main concerns associated with endopyelotomy. However, shorter hospital stay, and speedy return to normal activity and work are some of the positive highlights of endopyelotomy