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Kelina Hospital Carries Out Her First Laparoscopic Pyeloplasty

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PELVI-URETERIC JUNCTION OBSTRUCTION. LAPAROSCOPIC PYELOPLASTY. Pelvi-ureteric junction (PUJ) obstruction -or uretero-pelvic junction (UPJ) obstruction- is something that people are born with. The junction between kidney and the ureter(the small tube that carries urine from the kidney to the urinary bladder) is very tight, if not completely blocked, because the anatomy is not well developed while the baby is forming in the womb. Sometimes there is a blood vessel that crosses this point and causes obstruction to the urine flow. The kidney in PUJ obstruction is ballooned out, a condition called hydronephrosis. Urine cannot pass. Gradually, the kidney loses function. If it happens in both sides, the person can actually go into kidney failure.

In many countries, diagnosis can be made before the child is born and surgery can be done while the child is in the womb, even if it is just to pass a stent, a small tube, to allow the urine to pass into the bladder of the child. If this does not happen, the child makes less and less urine and amniotic fluid volumes are depleted. Without amniotic fluid, the child cannot float freely. Very tight space within the womb would not allow the child develop normally. This condition is called oligohydramnios. It causes several other problems for the unborn child. So it is very important for the unborn child to make a lot of urine within the womb, because this forms the bulk of the amniotic fluid. Congenital PUJ obstruction also damages the kidneys even before the child is born. The kidney material would be compressed and fail to develop normally.

When the condition is mild, the child can be born normally and can even grow into adulthood. But there tends to be a lot of pain in the flanks, the area where the kidney is located. The kidney affected is also hydronephrotic. Without repair, the damage to the kidney is irreversible.

Kidneys that are obstructed tend to form stones. They also get infected easily and subject to recurrent urinary tract infection. A distended, obstructed kidney is very painful.

Traditionally, repair has always been through open surgery. To the best of our knowledge, open surgery is what is practiced in Nigeria. In Kelina Hospital, on December 5, 2017, we did our first laparoscopic repair of PUJ obstruction. It is called laparoscopic pyeloplasty. The advantage of laparoscopic surgery is that there is minimal or no scar on the skin. For a girl especially, having a tummy free of scars is very important.

Other advantages of laparoscopic or Minimal Access Surgery are: • There is little or no blood loss • There is less Pain • The patient can return to work early • It allows easy repeatability • The Surgeon has better vision • There are less complications e.g. adhesions, injury to neighboring organs. • There is less transfusion rate with its associated problems e.g. infection • The patient has a higher quality of life after surgery.

Our patient was a 30-year old lady who did not want a scar. She also did not have enough funds to travel abroad where laparoscopic or robotic surgery is commonly done. Dr Undie, our Urologist, has had a lot of training in laparoscopic surgery. He also has Fellowship in this area. He led a team of doctors and nurses that was able to successfully carry out laparoscopic pyeloplasty yesterday. Surgery lasted 3 hours. Patient is doing fine and will go home later this week, without a scar on her tummy or need for blood transfusion.

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