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Blockages of the Ureter
If you have a narrowing at the outlet of the kidney or in the ureter (known as the "ureteropelvic junction" or "UPJ"), four different minimally invasive treatment options are available at the Urology Academic Practice. A narrowing can lead to incomplete emptying of urine with pain in the back and possible long-term loss of kidney function. Depending on how bad the problem is and other factors such as the presence of kidney stones, the treatment with the best expected outcomes will be recommended.
Ureteroscopy with Laser Incision
Ureteroscopy with laser incision is the treatment choice for most patients unless they have stones larger than one centimeter or a very distended (stretched out) kidney that has been blocked a long time. A tiny camera and a laser are used to open up the narrowing. A small drainage tube (stent) is left in the ureter for six weeks so the opening can heal properly. The treatment is an outpatient procedure. The stent is removed in a follow-up office visit.
Percutaneous Renal Surgery
Percutaneous renal surgery is the choice for the patients with a stricture and a kidney stone of larger than one centimeter. This is minimally invasive endoscopic surgery that allows the surgeon to perform surgery within the kidney using a small tract. A tract is an opening created by a small incision through the skin and tissues directly into the kidney. A sleeve bridges the distance from the skin into the kidney. Surgery is performed by guiding endoscopic instruments through the sleeve into the kidney. The stone is taken out and then the narrowing is made larger with a laser. Percutaneous renal surgery usually requires an overnight stay in the hospital.
Laparoscopic Fenger-plasty is the treatment of choice for patients with a long-time blockage and a very distended (stretched out) kidney. If stones are present, they are usually taken out during this procedure. Three little incisions are made into the abdomen to allow small surgical instruments to enter the kidney. The narrowed part of the kidney is cut and then rejoined so that there is a wider opening. A stent is placed either before this treatment or in the operating room. The stent is left in the ureter for approximately six weeks to allow it to heal properly (some patients may require more time for healing - some less. Your surgeon will tell you what to expect for your specific situation). The procedure requires an overnight stay in the hospital. The stent is removed at a follow-up office visit.