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Urologic Care for Conditions of Ureter

The ureters –– the long ducts that connect the kidney to the bladder –– can be compromised or can in their function of draining the kidneys for a number of different reasons.  These thin, delicate fibrovascular tubes, roughly a foot long, normally conduct urine from the kidneys to the bladder but are subject to problems for a number of reasons.  Because ureters are responsible for emptying the kidney, any condition of the ureter may require attention by a skilled urologic team, such as that at Virtua, as quickly as possible.

Ureters are, of course, often the focus or the access for efforts to relieve kidney stones.  They may also suffer from certain types of anatomical obstructions.  Diagnosis is through urine tests, X-rays and examination of the ureter with a cystoscope.

Evaluating a Critical Juncture

Ureteropelvic junction obstruction refers to any situation in which the ureter is not receiving urine properly from the respective kidney or not delivering it properly to the bladder, or both.  Such blockages can be the result of:

  • a narrowed segment due to injury from a urinary infection that has caused urethritis, or from a pelvic infection that has caused external adhesions that distort its shape, or from the passage of stones or from a previous surgery or invasive procedure (including for stones, hysterectomy, etc.);
  • eventual or progressive worsening of a structural abnormality that is congenital (present at birth);
  • a compressed accessory blood vessel;
  • pressure from a mass in the pelvis;
  • or a segment of the ureter that lacks the neurally-controlled wave-like rhythmic contractions necessary to transfer urine down to the bladder (referred as an aperistaltic segment of the ureter).

A blockage of the ureter can cause swelling of the kidney that brings on extreme pain similar to that from a kidney stone.  Backward flow of urine to the kidney can cause infection and kidney damage.  Ureteral conditions are a not-uncommon cause of eventual kidney conditions.   Though the back-up of urinary flow may be gradual, the need to treat the cause may be urgent.

To prevent severe symptoms and safeguard the function of the kidneys, Virtua’s urologists use all available tools to restore ureteral function, including robotic surgery.

Reparing Compromised Ureter with Robotic Assistance

Medications and other conservative measures are sometimes adequate care for a transient case of ureteral obstruction.  But for ureteropelvic junction obstructions caused by an intrinsic narrowing of the ureter, the gold standard of treatment is a surgical repair called a dismembered pyeloplasty, in which the Virtua urologic surgeon removes the strictured portion of the ureter and then reconnects the healthy tissue.  This surgery has a very high success rate.

Traditionally the urologist has conducted this operation as an open surgical procedure, requiring a large incision in the patient’s flank.  More recently, surgery via laparaoscopy has decreased the invasiveness of pyeloplasty.

Virtua surgeons have taken even greater advantage of this approach by increasingly conducting laparoscopic pyeloplasty using the robotic surgery system.  Robotic pyeloplasty has these advantages:

  • Several small incisions leave no scar and virtually no marks, and result in less post-operative pain.
  • Improved visualization and instrumentation make dissection and internal reconstruction quicker.
  • Patients experience less blood loss and shorter hospital stays.

In its service area, Virtua’s urologic team has been at the forefront of providing robotic pyeloplasty.

Bladder Infection

Urinary infections can affect the urethra, bladder, ureter, or kidneys, causing pain, bleeding, and other symptoms.  Virtua’s urologists have extensive experience screening for, diagnosing, and evaluating these infections and offering prompt, targeted, and complete medical treatment.

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