Urology | Hydronephrosis | Pyeloplasty FAQ

Pyeloplasty is the surgical reconstruction or revision of the renal pelvis to drain and decompress the kidney. In nearly all cases, the goal of pyeloplasty surgery is to relieve a uretero-pelvic junction (UPJ) obstruction.

Why does my child need a pyeloplasty?

A blockage at the connection of the kidney (renal pelvis) with the ureter, the tube that carries urine from the kidneys to the bladder, has been detected. This narrowing causes a ballooning out or dilation of the kidney called hydronephrosis. This usually can be verified by an ultrasound and kidney scan.

What causes the uretero-pelvic junction (UPJ) obstruction?

We don't know exactly, but we believe it is caused by an abnormal connection between the kidney and the ureter. This results in a kink and other deformities that make the situation worse.

Are any artificial parts used in the pyeloplasty surgery?

No. The original ureter is surgically approached below the level of the obstruction and the abnormal section is removed. Then the ureter is repositioned and reattached to the healthy renal pelvic tissue above.

Where is the incision?

The surgery can be done from a few different angles. In general, the incision will be on your child's side. Your surgeon will discuss the location of the incision that is the most appropriate for your child. All of the surgical stitches called sutures will dissolve. Occasionally, one skin suture is removed 10 days or so after the operation if a tube is inserted.

Are any tubes left in place after the surgery?

Surgeons use different approaches. In some cases, no tubes are left in place. In other cases, a tube called a "stent" may be left in place for seven to 10 days to drain the ureter or a kidney catheter tube called a nephrostomy may remain for 10 to 12 days. A small drain made of special, soft rubber, called a Penrose drain, may be left under the incision. The tube or drains are removed in the office with minimal, brief discomfort. The tube removal isn't painful, but may feel a bit strange.

Occasionally, a small amount of reddish-brown drainage may come out of the tubes or drains. The skin around the tubes may redden and have pus-like secretions. This is nothing to be alarmed about and is a natural reaction to the drain. Before you take your child home, we will help you feel comfortable assessing the tube and taking care of it at home. If no drain is left in place, the post-operative visit should be scheduled for two to four weeks after surgery.

While in the hospital, your child will have a catheter in the bladder to assure that the bladder and kidney are not stressed. Your child may experience bladder spasms or intermittent cramping. A medication called Ditropan will provide relief. The catheter will be removed before your child goes home.

How long will the surgery take?

The surgery takes about two to three hours. The operating room nurse will give your family periodic updates on the status of the surgery.

Can I stay with my child in the hospital?

Absolutely! We encourage parents to stay with their child. The nurses on the floor will help to make you comfortable. We also encourage siblings to visit unless they have colds.

What can I expect post-operatively?

While in the hospital, your child will receive medication as needed for pain. Toward the end of the procedure, your child may be given a caudal or epidural nerve block that will help control pain between the operation and waking up. The epidural catheter usually remains in place for about 48 hours.

Sometimes infants are given caudal morphine and then they are switched to oral pain medication. Younger children will be given pain medication, usually morphine, intravenously before the caudal wears off completely. Some older children are candidates for patient controlled analgesia (PCA) pumps. This involves infusion of the pain medication through the IV to maintain a more consistent blood level of pain medication. Please discuss the best form of pain control for your child with the anesthesiologist.

You will receive a prescription for pain medication that can be taken orally, usually Tylenol with codeine, at the time of discharge.

Will my child have any problems urinating after surgery?

After having a bladder catheter, it is common to experience the need to urinate frequently and to have some discomfort for the first few times your child urinates. Sitting the child in a shallow tub of warm water may provide relief. Placing a damp, warm washcloth on the perineum - the area between the anus and scrotum in males and between the anus and vulva in females -- may make the child more comfortable.

What kind of side effects do the medications have?

Many children lack interest in food following surgery. However, we ask that you continue to offer your child frequent fluids to maintain an adequate urine output. Even little sips every 15 minutes or so is great. Be creative with the way you offer liquids. If your child enjoys Popsicles, Jell-O or soup, offer these first for meals. Smoothies made from yogurt and fruit are a good source of vitamins and usually are tolerated well. This may require patience and persistence on your part.

Morphine, Droperidol or Demerol are among the medications your child may be given while in the hospital. These medications may make your child drowsy. Some children react to pain medication differently by becoming overexcited, nervous or developing a rash. If this happens, tell the nurse and the medication will be changed.

Before discharge, the medication will be switched to Tylenol with codeine, called Tyco. This comes in both tablet and liquid form. The codeine part of this medication can make some children constipated, so it is particularly important to encourage your child to be as active as possible. Provide plenty of liquids, fruits and vegetables when tolerated. Smoothies are a good source of vitamins and are usually tolerated well. Gradually, you can start to manage your child's discomfort with plain Tylenol as needed. Within a few days to a week after discharge, you should notice your child feeling more like him or herself again.

What is the follow-up after surgery?

Typically, a child is discharged on the second or third day after surgery. If a drain or catheter is in place, an office appointment should be made for one week after surgery to remove it. If there is no drain, schedule an appointment for four weeks after the surgery. It is important that your child continue the low-dose antibiotics until this time.

One to two months after the surgery, your child will be scheduled for an ultrasound of the kidneys. This test tells us if there is any blockage at the site of the surgery. Some surgeons may recommend repeating a renal scan to tell us about kidney function. Your child should then visit us for a follow-up six to eight months later for another ultrasound and office visit.

Children who have undergone successful pyeloplasty surgery may still get urinary tract infections. If you suspect your child has an infection, you should notify your child's pediatrician, or our office at (415) 353-2200.

Please contact our office if you are concerned with your child's progress after surgery or if your child exhibits any of the following:

This information is for educational purposes only and is not intended to replace the advice of your doctor or health care provider. We encourage you to discuss with your doctor any questions or concerns you may have.