Endopyelotomy

What is Endopyelotomy?

Endopyelotomy is an endoscopic procedure to treat ureteropelvic junction (UPJ) obstruction. The kidney is either approached through the Percutaneous Nephrostomy tube (from the side i.e. Antegrade Endopyelotomy) or through the urethra and urinary bladder (Retrograde Endopyelotomy). Endopyelotomy relieves the obstruction in the upper part of the ureter called the renal pelvis.

Where can I get Endopyelotomy?

Country	Cost with MedSolution
India	(Please inquire for price)

All prices are in US dollars and include the cost of the procedure and minimum hospital stay. Estimates and minimum hospital stay will vary depending upon individual needs and requirements.

Why is Endopyelotomy performed?

Obstruction of the ureteropelvic junction (UPJ) can be caused by congenital abnormalities like horseshoe kidney, fibrous scarring due to stone or previous operation, a blood vessel which may kink the UPJ or a stone that gets impacted in the upper part of ureter. This can cause damage to kidney tissue and eventually lead to pain, stone formation, infection, high blood pressure, deterioration of kidney function and eventually kidney failure. Endopyelotomy is a popular procedure to relieve all these symptoms.

Who is an ideal candidate for Endopyelotomy?

If you have obstruction of the ureteropelvic junction (UPJ) which can be caused by birth defects of the kidney like horseshoe kidney, fibrous scarring due to stone or previous operation, or if you have a blood vessel which may cause your ureteropelvic junction (UPJ) to kink or if you have a stone that gets impacted in the upper part of ureter, then you are an ideal candidate for Endopyelotomy.

How do I prepare for Endopyelotomy?

A thorough pre-operative assessment by your urologist would comprise of physical examination, Intravenous Pyelogram (IVP), urinalysis for the presence of blood and white cells and urine culture for infection are performed. Inform your surgeon about your other health conditions and medications (including all the prescription, non-prescription medications, nutritional supplements i.e. vitamins, minerals and herbal products) that you might be taking. Refrain from taking aspirin or Ibuprofen at least 2 weeks before Endopyelotomy. Stop smoking a few weeks before Endopyelotomy to prevent healing problems during recovery period. Do not eat or drink any thing for at least 10 - 12 hours before the Endopyelotomy.

What does the procedure for Endopyelotomy involve?

Two approaches are commonly used for Endopyelotomy, both these techniques are performed under general anesthesia. You will be required to stay in the hospital for 2 days following the Endopyelotomy procedure:

• Antegrade Endopyelotomy - In this procedure, the ureteropelvic junction of the kidney is approached from the side through the Nephrostomy tube. A blade is used to cut the UPJ and relieve the obstruction. The entire procedure takes about 2 - 3 hours. The nephrostomy tube is left in after Endopyelotomy.
• Retrograde Endopyelotomy - This procedure is performed by approaching the UPJ via the urethra. The Retrograde Endopyelotomy instrument contains a balloon that dilates and at the same time cuts to relieve the obstructed UPJ. This technique of Endopyelotomy is performed under general, regional or intravenous sedation. the entire procedure of Retrograde Endopyelotomy takes about 2 hours.

What is the recovery period like following Endopyelotomy?

You will spend the next few hours following Endopyelotomy, in the recovery under observation for your vital signs and immediate post-operative complications. You will be hospitalized for 24 - 48 hours following Endopyelotomy. Pain medication and antibiotics will be given post-operatively. In case of Antegrade Endopyelotomy, the Nephrostomy tube will be removed after 2 weeks. Avoid performing strenuous activities like lifting something heavy, jogging, treadmill or playing sports for at least 2 weeks after Endopyelotomy. You will be instructed to move around, avoid getting constipated, do some very simple breathing exercises to help prevent respiratory infections. You will be able to perform all your routine daily activities in about 2 - 4 weeks time after Endopyelotomy.

What is the outcome of Endopyelotomy?

Endopyelotomy almost has a success rate of 82 - 86%, there is reduced hospital stay (one day in younger, healthy patients), faster healing and quicker return to normal activity and work.

B . R . A . N . D . of Endopyelotomy

Benefits of Endopyelotomy

• Short hospital stay
• Quicker recovery
• Less pain during post-operative period following Endopyelotomy
• Less need for pain medication
• Quicker return to normal activity and work
• Smaller incisions and less scarring

Risks of Endopyelotomy

• Failure of the operation
• Excessive bleeding
• Infection (at the operation site or the urinary tract)
• Injury to other organs and tissues

Alternatives of Endopyelotomy

• Dilatation - Balloon dilatation by threading a balloon up your urinary bladder using a Cystoscopic technique.
• Open Pyeloplasty - In this procedure, an incision is made under the rib cage, the obstructed and narrowed part of the ureteropelvic junction is removed and the two ends are sewn back together.
• Laparoscopic Pyeloplasty - Laparoscopic Pyeloplasty is a minimally invasive Laparoscopic procedure which relieves the obstruction between the ureter and the kidney at the ureteropelvic junction (UPJ). Laparoscopic Pyeloplasty relieves the obstruction in the upper part (renal pelvis) of the ureter.

Now or Never

• Endopyelotomy has a high success rate and lower morbidity. However, it is a technically challenging surgery and is currently limited to major medical centers.

Decision to have Endopyelotomy

• Endopyelotomy is a minimally invasive procedure that requires a shorter hospital stay, quicker recovery and 86% success rate. Endopyelotomy has been mastered by several urologic surgeons and is a commonly used treatment for UPJ obstruction.