Treatments for Kidney and Ureteral Obstruction

Endopyelotomy and/or dilation of ureteral strictures

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These are a same-day surgery performed under intravenous sedation or general anesthesia to treat strictures (scar tissue causing obstruction) of the ureter. They represent minimally invasive, endoscopic treatments and therefore do not require any skin incisions. 

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Ureteral stenting and chronic stent exchanges

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Chronic obstruction of the ureter and kidney, whether due to scar tissue inside the ureter or other processes compressing the ureter from the outside, can be managed with insertion of a small, hollow tube into the ureter - called a "stent." Stents can provide temporary relief of obstruction for many patients until the time of definitive repair (see other procedures in this section). However, in few patients, definitive repair options are not available. In these cases, adequate drainage and function of the kidney is dependent on a stent. In such cases, stents need to be exchanged at regular intervals, typically every 3 to 12 months. The time length between exchanges is largely based on the underlying issue causing the obstruction and the surgeon's expertise. 

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Robotic surgery ("Robotic-assisted laparoscopic surgery")

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These are laparoscopic surgeries performed with the assistance of the da Vinci robotic surgical system. Using very small incisions and a camera, the surgeon is able to perform complex surgeries within the abdomen or pelvis. During these procedures, the surgeon is in control the entire time using master controls to manipulate the instruments - the robotic system translates the surgeon's movements into precise movements inside the body, helping to overcome some of the potential challenges of open surgery and traditional laparoscopic surgery. All surgeries are performed under general anesthesia and patients spend one night in the hospital after surgery.

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> Robotic Pyeloplasty

Pyeloplasty is performed to repair ureteropelvic junction (UPJ) obstruction or other obstructive processes in the upper part of the ureter (near the kidney). By removing a bad segment of the ureter, obstruction is removed and drainage of the kidney is repaired. 

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> Ureteral reimplantation

Blockages of the lower part of the ureter (close to the bladder) can be repaired by removing the faulty segment and plugging the ureter back into the top of the bladder, in an area that will ensure better kidney drainage. 

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> Other complex robotic ureteral reconstruction

This category represents a grab-bag of other surgical options for removing the obstructed portion of the ureter and reconstructing it to allow better kidney drainage. Complex cases includes those with very long segments of affected ureter and obstruction in the middle third of the ureter, among others. 

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