Urology Casablanca

 The intervention proposed to you is intended to repair the narrowing of the pyelo-ureteral junction that you present. Anatomical reminder The kidney is an organ that plays the role of a filter that purifies the blood and eliminates waste from the body. The kidneys are usually two in number. They are located in the abdomen under the chest, on either side of the spine. The urine secreted by the kidney passes into the renal cavities (chalices then renal pelvis), then is drained by the ureters towards the bladder where it is stored between two micturitions. The passage between the renal pelvis and the ureter is called the pyelo-ureteral junction. Legend: R: kidney; C: calyx; B: renal pelvis; U: ureter

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Why this action? You present with a narrowing of the junction between the renal pelvis and the ureter which was diagnosed by radiological examinations. This narrowing may be of congenital origin (channel too narrow or compression by a vessel) or following a disease that has caused inflammation of the area. The urine is retained at the level of the renal cavities and flows with difficulty towards the ureter. This restraint causes the cavities to expand. If left untreated, you are at risk of pain, infection and/or progressive kidney destruction. Are there other possibilities? In some special cases, a narrowing of the junction can be treated by natural means by endoscopic way by dilation or incision. Your urologist has explained to you why he is offering you this type of intervention.

Preparation for the intervention As with any surgery, a pre-operative anesthesia consultation is required a few days before the operation. The urine must be sterile for the operation: a urine analysis is carried out before the intervention to check the sterility of the urine or to treat a possible infection, which could lead to postponing the date of your operation. The operation takes place under general anesthesia Surgical technique Several approaches allow pyeloplasty to be performed by surgery or laparoscopic surgery. The choice will be made according to the type of narrowing, your morphology and the habits of your surgeon. The technique consists of performing an intervention at the level of the pyelo-ureteral junction to remove the narrowed part and restore a normal passage between the renal pelvis and the ureter. At the end of the intervention, the urologist sets up a tutor catheter allowing the drainage of urine during the healing period. It can be an internal probe, called the JJ probe, which will be removed by natural means a few weeks later, or a probe coming out through the skin which will be removed after a few days according to the surgeon's indications. One or more external drains can be placed temporarily. They make it possible to monitor any postoperative discharge.

During the surgical procedure - Injury to nearby organs justifying their repair or removal. - Vascular injury responsible for bleeding that may require a blood transfusion. - Repair of the pyelo-ureteral junction impossible due to anatomical difficulties; in this case, your surgeon may decide to modify the operation, or even remove the kidney. In the immediate postoperative suites - Bleeding that may require a new operation. - Risk of urinary or wall infection (i.e. of the skin and muscles covering the operated area). - Digestive complications: delay in the resumption of intestinal transit or true occlusion. - Urinary fistula due to poor healing of the excretory tract, causing urine to leak into the abdomen, through wall drainage or through the scar. Your surgeon may suggest draining the excretory tract using an external ureteral catheter or an internal double J catheter to dry up the fistula. Nevertheless, in case of failure, a new operation may be indicated to close the excretory pathway, or even to remove the kidney. Remote Risks - As in any abdominal operation, deformations of the wall of the abdomen, more or less important, and intra-abdominal flanges can occur. - Recurrence of the narrowing which may require a new operation by endoscopic or surgical way. Your urologist is at your disposal for any information.

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