WHY THIS INTERVENTION?

The tests requested by your doctor revealed a narrowing of the junction between the renal pelvis and the ureter. This narrowing can be of congenital origin (canal too narrow or compression by a vessel) or following an illness or an intervention. Urine retained in the kidney cavities has difficulty flowing towards the ureter. This retention causes dilation of the kidney cavities. Failure to treat it exposes you to the risk of pain, infection, stones, high blood pressure and progressive destruction of the kidney.

ARE THERE OTHER POSSIBILITIES?

In some cases simple monitoring is enough. In certain cases the treatment can be carried out endoscopically by dilation or incision of the junction. Sometimes ureteral drainage (double J probe) will be offered in the long term with regular change of the probe. Your urologist explains to you why he is offering you this type of intervention.

PREPARATION FOR THE INTERVENTION

Any surgical intervention requires preparation which may vary depending on each individual. It is essential that you follow the recommendations given to you by your urologist and your anesthesiologist. If these recommendations are not followed, the intervention could be postponed.

Before each surgical procedure, a pre-operative anesthesia consultation is mandatory. It is imperative to inform your urologist and the anesthesiologist of your medical, surgical and allergic history and your current treatments, in particular oral or injectable anticoagulants or antiplatelet agents (aspirin, clopidogrel, anti-vitamin K, etc.). Their use increases the risk of bleeding during the procedure. This treatment may be adapted and possibly modified before the intervention. A urine analysis is carried out before the operation to check sterility or treat a possible infection, which could lead to the date of your operation being postponed.

OPERATIVE TECHNIQUE

The procedure takes place under general anesthesia. Several approaches allow pyeloplasty to be performed: PATIENT INFO SHEET | PYELOPLASTY 3/9

▪ A classic incision on the side of the abdomen (lombotomy)

▪ A laparoscopic approach with or without robotic assistance

The choice is made according to the type of stricture, your morphology and the habits of your surgeon. Generally, the technique consists of treating the abnormality of the pyelo-ureteral junction by removing or widening the narrowed part, then suturing the urinary tract to restore a normal passage between the pelvis and the ureter. At the end of the procedure, a ureteral catheter (double J) is placed (which is removed naturally a few weeks later) as well as drains which will allow the flow from the surgical site to be monitored. The surgical specimen is analyzed in the laboratory.

USUAL FOLLOW-UP, RETURN HOME

All surgery requires rest and a reduction in physical activities. It is essential to rest and only resume your activities after approval from your surgeon. In the event of an emergency, your urologist will give you instructions on how to contact him, in case of difficulty contacting him, do so on the 15th.

To monitor the proper functioning of the kidneys and prevent you from having urinary difficulties upon waking up, a catheter urinary can be put in place during the procedure. This probe may be responsible for discomfort. In certain cases, the stomach is suctioned through a small probe exiting through a nostril, in order to avoid vomiting, a source of pain in the scar and respiratory complications.

Post-operative pain is managed by administering analgesics. Removal of the drain(s) and urinary catheter is defined by the surgeon.

The length of hospitalization varies and a convalescence of a few weeks is necessary. You will discuss with your surgeon the date of resuming your activities and the follow-up after the operation. You are advised to avoid any significant effort or movement in the first month following the procedure.

Prescriptions given upon discharge may include treatment as well as the daily injection of an anticoagulant. Maintaining anticoagulant treatment is necessary after your hospitalization to prevent the risk of phlebitis. Wearing compression stockings may be desirable for at least 10 days after the procedure.

A letter is sent to your attending physician to keep him informed of your state of health. The duration of convalescence and the date of return to work or normal physical activity depend on your physical condition and the procedure performed. You will discuss with your urologist the date of resuming your activities and follow-up after the operation