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Endopyelotomy Surgery
Ureteropelvic junction (UPJ) obstruction is best-treated using Endopyelotomy, a minimally invasive endoscopic procedure. The kidney is accessed using a Percutaneous Nephrostomy tube or it may be accessed through the urethra and urinary bladder.
Endopyelotomy helps to resolve the problems caused by obstruction in the renal pelvis.
Am I an ideal candidate for Endopyelotomy?
You are an ideal candidate for an Endopyelotomy, if you:
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Have obstruction of the UPJ (ureteropelvic junction) caused by congenital disorders (horseshoe kidney, etc)
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Develop fibrous scarring due to stone or prior surgery
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Have a damaged blood vessel which risks affecting your UPJ
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Develop a stone that gets lodged in the upper part of the ureter
Apart from this, the doctor will also take into consideration your age, medical history and your current overall health condition before giving the go-ahead for your surgery.
How can I prepare for the Endopyelotomy surgery?
Pre-operative instructions for Endopyelotomy usually include providing your surgeon with your medical history and latest test reports. The doctor will want to know if you have developed any other diseases, even as small as a common cold.
Generally, if the doctor, surgeon or anesthesiologist suggests otherwise, you should be better off by observing these points:
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1 week to surgery – Stop headache medications and any other medication which contains aspirin.
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2 days to surgery – Stop all NSAID (non-steroidal anti-inflammatory drug) medications, such as ibuprofen, etc.
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1 day to surgery – Start the bowel cleansing procedure which has been prescribed for the particular surgery.
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On surgery day – In the morning avoid taking any medications, oral anti-diabetes, etc. You can take ½ of your normal morning Insulin dose. Bring your asthma inhaler (if you use one) with you to the hospital. Take your other medications with a sip of water.
Diet before surgery
Unless the surgeon, doctor or anesthesiologist specifies otherwise you should follow these dietary instructions:
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8 hours before surgery – Stop eating solid foods, including juices which have pulp. Also refrain from chewing gum, candy, lozenges and mints. Also avoid full liquid foods, such as cream, milk or jell-o. You can drink water, coffee, black tea and clear juices up to 6 hours before the surgery.
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6 hours before surgery – Stop eating any food items, apart from the normal medications.
If you are to undergo a diagnostic or operative procedure which requires you to be sedated then you should stop eating or drinking anything orally as mentioned in the pre-operative dietary instructions. This prevents nausea or vomiting while you are sedated.
How is Endopyelotomy performed?
There are two commonly used surgical approaches for performing an Endopyelotomy. Both of these techniques require administering general anesthesia. This is to prevent any discomfort or pain to you when the procedure is underway.
These are the two types of Endopyelotomy procedures:
Antegrade Endopyelotomy
This requires accessing the Ureteropelvic Junction of the kidney through a Nephrostomy tube from the side. A surgical blade cuts the UPJ and removes the blockage.
This procedure usually takes around 2 to 3 hours and the surgeon will keep the Nephrostomy tube inserted after the surgery.
Retrograde Endopyelotomy
The urethra is used to access the UPJ in this procedure. It uses an inflatable surgical balloon which dilates and simultaneously removes the blockage from the UPJ.
What are the instructions to follow after the surgery?
These are the general instructions which you are expected to follow after an Endopyelotomy:
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Rest today
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Resume normal diet however faint nausea might be present for a while due to the anesthetic.
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Drink sufficient amounts of fluids. Experts recommend having around 24 to 32 oz above your usual daily intake. However, avoid coffee – even decaf – along with tea, alcohol as well as carbonated products.
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Some pain or burning might be present while urinating. Blood might also mix with the urine. However, this will be over within 2 to 3 days.
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Refrain from sexual activity for at least a week.
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Schedule a follow-up appointment with the urologist and get the necessary medications proscribed.
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In case a ureteral stent was attached, you may have an urge to urinate frequently, there might be blood in the urine and an occasional uncomfortable sensation.
In case you undergo minimally invasive endoscopic procedure:
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You may feel a burning sensation for around 2 to 3 days.
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Blood may be seen while urinating for at least 3 to 5 days, with gradual improvement.
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Bladder may become irritable and cause urgency, incontinence or frequency.
How is the recovery following Endopyelotomy?
The couple of hours immediately following an Endopyelotomy is spent in the recovery room, where your vital signs are monitored closely to detect complications. You will be required to stay in the hospital for at least 24 to 48 hours following the surgery. Antibiotics and painkillers are prescribed in the initial recovery period in case of excess pain and to prevent infection.
The Nephrostomy tube attached in the antegrade Endopyelotomy is normally removed after 2 weeks. Avoid stressful physical activity and lifting heavy objects for at least 2 weeks till after the surgery.
The surgeon or doctor will instruct you to remain mobile to help avoid constipation and also breathing exercises that prevent respiratory infections.
You will be able to resume normal everyday activities within 2 to 4 weeks following the Endopyelotomy.
How successful is an Endopyelotomy?
The success rate of an Endopyelotomy is significantly high at around 82% to 86%. The hospital stay is also considerably shorter with a faster healing and recovery period.
What are the benefits of an Endopyelotomy?
These are the benefits of an Endopyelotomy:
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Shorter hospital stay
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Faster recovery
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Minimum pain or discomfort following the surgery
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Less need for painkillers
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Smaller incisions leave minimal scarring
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Faster resuming of normal everyday activities
Are there any risks associated with Endopyelotomy?
There is the usual risk which is associated with almost every surgery, such as:
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Infection
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Bleeding
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Transfusion
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Unsuccessful procedure
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Wound infection
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Pain
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Scarred tissue
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DVT
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Myocardial infraction
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Pulmonary embolus
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Injury/damage to surrounding tissue/organs
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Heart failure
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Stroke
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Death
There are rare risks associated with the Endopyelotomy procedure, which include:
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Unsuccessful procedure
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Stone formation
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Blockage
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Pyonephrosis
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Pyelonephritis
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Vascular structure damage
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Damage to artery of the gonad
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Loss of ovary/testicle
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Tract bleeding
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Bowel injury
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Constant flank pain
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Percutaneous renal drainage
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Renal hematoma
You need to read and understand all possible advantages, benefits, risks of complications from this surgery carefully and get all information and details you need from your doctor or surgeon. There might be additional types of risks from an Endopyelotomy which might not have been covered above.
Endopyelotomy Surgery in India
India seems to offer the cheapest medical services, while other western countries are slightly more expensive. The cost of endopyelotomy surgery in India is much affordable of what similar treatment would cost you in the United States. India's health care services industry is poised to become a major driver of economic growth as first-world patients, driven out of their own systems by high costs and crowded conditions, look for cheaper places for medical care. The health care sector in India has witnessed an enormous growth in the increasing number of patients coming to India for their treatment. The private sector which was very modest in the early stages has now become a flourishing industry equipped with the most modern state-of-the-art technology at its disposal.
