Question

Write about other reconstructive procedures involving ureteropelvic junction (Non Anderson-Hynes).

Hint:

Minimally invasive approaches, such as laparoscopic or robotic-assisted surgery, offer reduced recovery times and better cosmetic outcomes in the management of UPJ obstruction.

Answer 1

Step 1: Overview of Ureteropelvic Junction (UPJ) Obstruction:
Ureteropelvic junction (UPJ) obstruction is a common cause of hydronephrosis, which occurs due to a blockage at the junction where the renal pelvis meets the ureter. This obstruction can be congenital or acquired and results in impaired renal drainage, leading to renal damage if untreated.
Step 2: Non-Anderson-Hynes Procedures:
The Anderson-Hynes pyeloplasty is the most widely used surgical procedure for UPJ obstruction. However, non-Anderson-Hynes approaches can also be used for reconstructive purposes, especially in specific clinical scenarios.
Step 3: Pyelotomy and Ureterostomy:
In cases where the Anderson-Hynes pyeloplasty is not suitable, a pyelotomy (incision of the renal pelvis) can be performed, followed by ureterostomy (opening of the ureter). This procedure can allow for the relief of the obstruction by directly creating an opening in the obstructed area.
Step 4: Ureteral Reimplantation:
For some patients with UPJ obstruction, particularly those with a long segment of obstruction or associated reflux, ureteral reimplantation may be performed. This involves reimplanting the ureter into the renal pelvis or bladder to bypass the obstruction and re-establish proper drainage.
Step 5: Laparoscopic or Robotic-Assisted Surgery:
Advances in minimally invasive surgery, such as laparoscopic or robotic-assisted pyeloplasty, have become viable alternatives to traditional open surgery. These procedures involve smaller incisions and faster recovery times, while still effectively managing the UPJ obstruction.
Step 6: Percutaneous Nephrostomy and Endopyelotomy:
For some patients, a percutaneous nephrostomy may be placed for drainage, followed by endopyelotomy, which involves a minimally invasive incision of the obstructed area to allow for proper urine flow. This option is suitable for certain cases with complex or recurrent obstructions.