An obstruction at the level where the kidney meets the ureter is referred to as a ureteral pelvic obstruction. Such an obstruction may have several causes, the most common of which is a congenital malformation (the patient is born with the obstruction). In these patients the obstruction may not become evident until later in life. Other causes of ureteral pelvic obstruction include stone disease, infection, and trauma. Once the diagnosis is made, testing must be performed to determine if the obstruction should be repaired (pyeloplasty) or the kidney should be removed (nephrectomy).
The patient undergoes general anesthesia for this procedure. Four to five small cylindrical tubes called trocars are placed in the patient's side just below the ribs. The trocars allow entry of a video-telescope, called a laparoscope, that provides a view of the entire abdominal cavity and kidney. The video-telescope gives the surgeon a magnified view of the operating field and allows identification of vessels and structures with more clarity than is possible in open surgery. Additional small trocars allow the introduction of instruments necessary for the surgery. When all of the trocars and instruments are in place, the obstructed portion of ureter is identified and cut out. The ureter is then reattached in such a way as to prevent obstruction in the future.
Long-term results of laparoscopic pyeloplasty have confirmed that complications remain low, blood loss is minimal, and outcomes are excellent, paralleling those achieved with the standard open technique.