What Is a Pyeloplasty?

A pyeloplasty is done when the tube that drains urine from the kidney and into the bladder is blocked. This pushes the urine back into the kidney, which can cause loss of kidney function, infections and pain. Pyeloplasty can help fix these problems and prevent them from getting worse or coming back.

Conditions that may require pyeloplasty in children include:

• An adynamic ureter or blocked UPJ – In many children, the blockage develops before birth with a small, tight area that is simply too narrow for enough urine to get past. In other children, the UPJ is normal but something outside of the ureter causes the blockage, such as a crossing vessel. This is called an external blocked UPJ, which typically occurs in older children.
• Rarer causes – These include blockages caused by polyps, tumors or scarring.

Many cases of blocked tubes are diagnosed before birth when a swollen kidney (hydronephrosis) is found on an ultrasound. These children get ultrasounds and other types of imaging after birth to find out the cause of the blockage and whether it will require surgery.

In other cases, children see a doctor because of symptoms that are later found to be caused by a blocked urine tube, such as flank or back or abdominal pain and vomiting, urinary tract infections, blood in their urine, or kidney stones.

Once a problem is diagnosed and the doctor says surgery is needed, your child will be scheduled for the operation. Pyeloplasty is generally not an emergency surgery.

Your doctor will go over the plan for surgery and what to expect in the office visit before your planned surgery.

After that, a nurse from Nationwide Children’s will call 1-3 days before the operation to give instructions and the exact time of the surgery. The nurse will let you know when to arrive, when your child needs to stop eating or drinking, and any other information you need to know for the day of the operation. No matter what technique the surgeon uses, pyeloplasty requires an overnight stay at the hospital.

1. Your child will be put to sleep using medicine (general anesthesia). A catheter will be put in place for the surgery and left in overnight.
   • If the surgery is minimally invasive, the doctor will also put in a stent (a small tube) into the urine tube to help it heal better after the surgery. The stent will stay in place for several weeks after surgery.
   • If the surgery is open, the doctor may put in a small tube to drain urine from the affected kidney to the outside of the body (called an external drain) until the kidney and urine tube are healed. This will stay in place for a few days to weeks after surgery.
2. Your child will receive at least one dose of antibiotics to help lower the chance of an infection at the site of the incisions.
3. Your surgeon may take last minute pictures by shooting dye up your child’s ureter to the kidney to confirm there is a blockage. This is done to better visualize your child’s anatomy, without any cuts. This is called cystoschopy and a retrograde pyelogram.
4. The surgery will last for a few hours. A surgery nurse will call you from time to time or update you via an app on your phone to let you know how your child is doing.
5. In the recovery room, your child will be checked for complications. If there are no signs of a problem, he or she will be given pain medicine and sent to recover in their hospital room, where you will meet them.
6. Your child may have visible blood in the urine after surgery. This is normal.
7. If your child is doing well, he or she may be sent home the following day, after the surgery team checks on them.

If your child receives a stent, you will have to return to the hospital in 4-6 weeks. It will be removed under general anesthesia but your child should be able to go home that same day. There are no incisions or cuts made for this surgery. A follow-up ultrasound will be done 1-3 months after the surgery to check on the kidney and urine tube. In some cases, more imaging may be needed for up to 6-12 months after the operation, since it can take time for kidney swelling to go down and to know for sure how well the urine tube is draining.

You should also expect the following after pyeloplasty:

• The skin is usually closed with internal, absorbable stitches and skin glue. These disappear on their own and don’t require any special removal or care.
• Your child can wash by sponge bath for the 2 days following the surgery. The incision should not be submerged in water for 2 weeks after the operation (showers are okay), or until the external drain is removed (in babies).
• The site of the cut may be sore for a few days or weeks. Some children have discomfort or a little pain from the stent the entire time it is in place.
• Your child may have blood in the urine as long as the stent is there.
• Your child can return to normal activities within 3-5 days of the operation. However, older children should avoid contact sports for a few weeks. Children with internal stents are allowed to be active if they are comfortable.
• You will be asked to continue to follow-up in our office with imaging for a while to be sure the surgery is successful.

You should call the doctor or seek medical attention for your child after pyeloplasty if your child:

• Has a fever of 101° F or higher before the follow-up visit
• Passes large blood clots in the urine
• Complains of severe pain in the belly, side or back that isn’t helped by the pain medicine they are given at discharge
• Has symptoms of a urinary tract infection (UTI)
• Is unable to stay hydrated due to excessive vomitting

If pyeloplasty is needed, it can protect the kidney from damage and help it function better than when it was blocked. If the procedure is successful, it can also help your child avoid urinary tract infections and pain in the future.

By keeping the affected kidney healthy and working well, the other kidney will not become over-stressed. Having two healthy kidneys gives your child the chance for better health down the road in case another health problem injures or affects the kidneys.

In general, the risks of a pyeloplasty include those of any surgery, such as infection, redness, swelling, bleeding, or failure of the operation to fix the problem. During surgery on the kidney, however, urine can leak into other areas and cause irritation.

Rarely, the place where the urine tube is stitched together forms a scar that blocks urine from getting to the bladder. This results in the tube becoming blocked again. In these cases, your child may require another operation to cut through the scar tissue or remove the new blockage. Sometimes this new blockage can be dilated by the radiologists without another surgery. Sometimes urine can continue to leak where the urine tube is stitched together which might require another tube to help drain it.

• Why is a pyeloplasty needed?
• Are there any alternative treatment options?
• What would happen without the surgery?
• What should your child expect for recovery?
• What is the best plan for follow-up care and imaging?
• When and how will you know that the surgery worked?
• What are the potential risks and benefits for your child?
• What surgical techniques are available?
• What technique does the doctor recommend, and why?

When your child undergoes surgery, there are many things to consider. At Nationwide Children’s, your child will be operated on by skilled surgeons at a world-class hospital. When possible, our team uses minimally invasive surgery (laparoscopic and robot-assisted). These techniques have the benefit of leaving smaller incisions and less scarring. They often heal faster, allowing kids to return to normal activity sooner than open surgery.

Surgeons at Nationwide Children’s also attempt to hide incisions and scars in the belly button or below the underwear line to make them as unobtrusive as possible. This approach, called HIdES (hidden incision endoscopic surgery), places value not just on the current health needs of your child, but also his or her long-term wellbeing.

There are ongoing studies at Nationwide Children’s to investigate how to better evaluate children in need of a pyeloplasty. We are performing cutting-edge research to find changes in the urine that could suggest that surgery is needed. If you are interested, you may be invited to take part in our study.

When your child is a patient of the Urology team at Nationwide Children’s, you will feel like a valued member of the care team. Our physicians and support staff work with patients and their families to ensure a streamlined, communicative experience from the time you first visit us until your child’s final follow-up appointment.