Robot-assisted da Vinci pyeloplasty for ureteropelvic junction obstruction

Urine is produced in the kidney and released into the renal pelvis. From there, it flows through the ureter into the urinary bladder. At the junction between the renal pelvis and the ureter, there is one of the three natural narrowings of the ureter, which under normal circumstances does not impair the flow of urine. However, if this results in an obstruction to the flow of urine, it is referred to as ureteropelvic junction obstruction or subpelvic stenosis.

If, for example, the patient suffers from flank pain, a pyeloplasty may be necessary. The same applies if the examination results show impaired urine transport or a deterioration in kidney function.

The narrowing at the junction between the renal pelvis and the ureter is eliminated by a surgical procedure on the kidney. This operation is performed by an experienced specialist in urology. The reconstructive procedure widens the area by suturing the body's own tissue from the renal pelvis into the area of the former narrowing.

After the operation, the renal calyces or the renal pelvis often remain dilated as a sign of chronic widening. As long as there are no symptoms or urinary retention, this finding has no therapeutic consequences and merely requires monitoring. However, if the patient has flank pain or kidney function deteriorates, renewed treatment must be considered.

Patients are admitted for robot-assisted da Vinci pyeloplasty on the day before the operation. The operation takes place under general anaesthesia. The robot's minimally invasive instruments are inserted into the abdominal cavity using keyhole surgery. Under three-dimensional vision, the surgeon carefully exposes the narrowing at the junction of the renal pelvis and the ureter. After removal of the narrowing, robot-assisted surgery allows an exact suture between the renal pelvis and the ureter. The anastomosis created in this way is secured with an internal ureteral stent. This stent remains in place for approx. 6 weeks and is removed endoscopically during a later outpatient treatment. The entire inpatient stay lasts approximately 5–7 days.

In contrast to conventional laparoscopic pyeloplasty, robot-assisted da Vinci pyeloplasty is performed with high magnification of the surgical site. This allows the tissue to be dissected more precisely. In addition, robot-assisted pyeloplasty allows a shorter operating time thanks to the greater mobility of the instruments.

As a rule, professional activities such as office work are possible again 2–3 weeks after the operation. The ureteral stent is removed approx. 6 weeks after the pyeloplasty. The flow of urine from the renal pelvis is then checked. Sporting activities or more strenuous physical exertion can then be resumed. After discharge from inpatient treatment, outpatient care is provided at the Goldstadt Private Clinic.

Pyeloplasty is performed under general anaesthesia. Due to the very small incisions in robot-assisted da Vinci pyeloplasty, virtually no pain is to be expected after the operation. The ureteral stent is removed after approx. 6 weeks by means of an outpatient cystoscopy, flexible if necessary.

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