Diagnosis: How to diagnose joint ureteropelvic junction stenosis?


Besides a simple conversation with the patient (anamnesis) focused on the patient's symptoms, the diagnosis is usually made through radiological examinations such as abdominal ultrasound, abdominal CT with contrast and sequential renal scintigraphy.


There are other tests useful for the diagnosis of ureteropelvic junction stenosis such as blood PSA (prostate specific antigen), uroflowmetry with evaluation of post-void residual (in order to objectify the urinary flow and to verify any failure to empty the bladder after urination) and transrectal prostate ultrasonography (to precisely evaluate prostate volume in anticipation of possible un-obstructive intervention).


Treatment: How is ureteropelvic junction stenosis treated?

Stenosis of the urinary tract junction ureter, as well as any other ureteral narrowing, cannot be solved with a drug therapy and requires corrective surgery. The procedure, which is called pyeloplasty, is sectioning and removing the diseased portion of the ureter and subsequent stitching of the two remaining ends of the enclosure. 


The evolution of this surgical technique has grown from an initial approach as an open surgery (now indicated only in isolated cases), laparoscopic access (now abandoned), endoscopic approach (only rare cases of relapse) and a robotic assisted laparoscopic approach that has now become the treatment of choice at our center. The latter approach has evolved (July 2011) as Our center has the first robotic approach in the world with a "single technical site" i.e. a single incision in the navel to perform the surgery.


What happens during the robotic pyeloplasty surgery?


The surgery is done with a minimally invasive robotic technique thanks to the Da Vinci robotic system. The use of robotics technology (magnified vision, greater possibility of movement of the instruments, elimination of tremor) allows us to obtain greater precision in pyeloplasty. Under general anesthesia, the patient is positioned on the side with the bed at 30 degrees angle.


In some cases (traditional robotic technique), 3 operating doors of less than 1 cm are used and a fourth of 1.5cm. In other cases (single robotic technique site), a single incision in the navel of 2.5cm is sufficient to perform the procedure.


The procedure consists in the sectioning and removal of the diseased portion of the ureter and in the subsequent sewing of the two remaining ends of the conduit. In order to heal properly, this suture is necessary to be positioned within the ureter of a small catheter with the top end in the kidney and the lower one in the bladder. This brace is not seen from the outside and it is removed in the clinic a month after surgery. The procedure lasts about 1-2 hours. 


The steps that lead to the discharge, which occurs on average only 3-4 days post surgery, include the removal of the bladder catheter 2 days after surgery and the removal of the drainage 3 group after the intervention. To date, our series boasts more than 100 cases and it is one of the most significant in the world. Moreover, our group was the first in the world to propose the intervention of robotic, single site pyeloplasty or through a single incision of 2.5cm in the navel.


The huge interest in this new surgical technique has had great success at the national level but above all internationally. Both the Italian Society of Urology (SIU) and the European Society of Urology (EAU) in collaboration with the now appendix or the European Society of Robotics (ERUS/ESUT) has since 2006 annually invited us to participate in the European conference and share our experience on the joint ureteropelvic junction with presentations of our results and operations performed in live surgery.


How will I feel after the pyeloplasty intervention?

The aim of the intervention is the resolution of the block to the flow of urine from the kidney, resulting in the resolution of symptoms (colic, recurrent infections) as well as the preservation of kidney function.


How will I be monitored after the surgery?


Our protocol provides for a follow-up evaluation at one month after surgery with blood tests, urinalysis and urine culture, as well as an ultrasound of the abdomen and removal of the ureteral catheter. All further control tests are ultrasound of the abdomen at three months and then six months after the procedure and finally renal scintigraphy at six months post surgery.


Our results


Our results were published in the prestigious international European Urology journal, first with our preliminary data on the robotic pyeloplasty with traditional approach published in 2010 and later with the "single technical site" published in 2012.


§  http://www.ncbi.nlm.nih.gov/pubmed/24656756

§  www.ncbi.nlm.nih.gov/pubmed/20800338

§  www.ncbi.nlm.nih.gov/pubmed/22469392


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