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Laparoscopic pyeloplasty

 
Guidance issued
 
Number: IPG46

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic pyeloplasty.

Description

If the transition from the renal pelvis to the ureter is narrow, the urine will not drain easily and backs up causing dilatation of the collecting system proximal (behind) to that point and enlargement of the renal pelvis. This dilatation of the collecting system is referred to as hydronephrosis. UPJ obstruction is usually congenital, but may also be acquired (i.e. secondary to other disease processes or previous instrumentation).

A pyeloplasty is a surgical procedure that is indicated for a ureteropelvic junction (UPJ) obstruction. The UPJ is the portion of the collection system that connects the renal pelvis (the larger collecting portion of the kidney that is funnel shaped and tapers down to the ureter) to the ureter. The standard intervention for ureteropelvic junction obstruction is open pyeloplasty.

Many individuals with a UPJ obstruction do not realize they have this condition until later in life, when the poorly flowing urine becomes infected, or they begin developing symptoms such as pain.

Although different types of pyeloplasty operations have been described, the ultimate goal is to remove the narrowed portion of the UPJ, refashion the renal pelvis, and attach it to the ureter in a way to allow for easy drainage of urine down the ureter. There are different ways to approach the kidney to perform the operation. These include via a flank incision, subcostal (under the rib) incision, transabdominal approach, or even sometimes through an incision in the back.

 

 

OPCS code:

Details

Arrangement:
Normal
Topic area:
Surgical procedures
Urogenital
Specialty:
Urology
Specialist advice has been sought from:
British Association of Urological Surgeons
Date notified to NICE:
01 April 2002
Guidance issue date:
24 March 2004

Contact details:

Project manager (for general enquiries or comments)
(for general enquiries or comments)
Ben Doak
Contact Address:

Interventional Procedures Programme
National Institute for Health and Clinical Excellence
MidCity Place
71 High Holborn
London
WC1V 6NA

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