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UROLOGY A less invasive approach to a common kidney problem
It’s the little things BY MAUREEN KOVACIK
Methodist urologist uses less invasive approach to fix common kidney problem
A handful of coins — a few quarters and dimes — can be the difference between hunger and a full stomach for a homeless person who will sleep under a bridge tonight. It’s the little things in life — small, seemingly insignificant things that can have a huge, positive impact.
On the other hand, a minuscule blockage the size of a grain of rice, can wreak havoc on the body and lead to kidney failure, but luckily, a surgical advance using incisions just millimeters long can improve treatment for patients who suffer from a urological condition called ureteropelvic junction obstruction.
The problem presents itself
Ureteropelvic junction obstructions (UPJ) occur when the renal pelvis, the area that connects part of the kidney to the ureter, is blocked. The condition is most commonly congenital, meaning it was present prior to the patient’s birth. The symptoms are usually slow to develop but, if left untreated, can lead to the destruction of the kidney.
UPJ causes sudden pain in the side, usually after drinking large quantities of fluids. The kidneys produce urine more quickly than the ureters, the tubes that bring the urine to the bladder, can drain it from the renal pelvis because of the blockage. The kidneys then swell, creating pressure in the pelvis. This swelling is called hydronephrosis.
A patient who ends up in the doctor’s office with symptoms such as back pain, a urinary tract infection and/or fever, a kidney infection, bloody urine, and/or a lump in the abdomen may be suffering from hydronephrosis.
“If there is an infection in addition to the blockage, this can take as little as three days to occur,” said Dr. Richard Goldfarb, a urologist with The Methodist Hospital. “However, in most cases, it takes about six weeks for the kidney to stop functioning.” In cases when the blockage is partial, progressive loss of kidney function can occur over many years.
In addition to UPJ, Goldfarb says the blockage also can occur due to kidney stones and chronic conditions such as cancer or scar tissue. FEMALE
A minimally invasive fix
One of the most common ways to fix UPJ is a procedure called pyeloplasty, in which the surgeon removes scar tissue from the blocked area and connects the healthy part of the kidney to the healthy portion of the ureter. Doctors at Methodist are now routinely performing this procedure laparoscopically (using small incisions).
Pyeloplasty was originally performed surgically through a 10-inch incision made in the patient’s side, but during the 1990s, doctors were looking for a more minimally invasive approach.
“We are always looking for ways to make surgery and the recovery process easier on patients,” said Methodist urologist Dr. Richard Link. “Laparoscopic pyeloplasty provides the same benefits as the traditional surgical method but with more rapid recovery times and less pain.” The procedure involves making three to four incisions the width of a small pencil. Most patients go home in 24 to 48 hours, experience less pain and wound complications and fully recover in four to six weeks. The majority of patients (>95 percent) also experience no more symptoms after the surgery, and the loss of kidney function is halted. Link not only has performed a large volume of regular laparoscopic procedures, but also pioneered the use of the da Vinci surgical robot for pyeloplasty at Methodist. The
da Vinci robot uses advanced optics to allow the surgeon to view the operation at a high magnification and in 3-D as opposed to the 2-D perspective of standard laparoscopic surgery. It also provides surgeons with a wider range of motion, and maneuverability than standard laparoscopic surgery. (See page 7 for more information on da Vinci.)
“At Methodist, we most likely treat the largest number of patients in the Houston area with this technique,” said Link, an associate professor of urology at Baylor College of Medicine and director of the Division of Endourology and Minimally Invasive Surgery. “About 65 percent of our patients are new and the other 35 percent come to us for a repair after their initial surgery elsewhere was unsuccessful.”
In the know
Not only are doctors at Methodist performing laparoscopic pyeloplasty successfully, but they also are teaching it to others. Link, for example, teaches the procedure for the American Urological Association’s Mentored Laparoscopic Course.
“As the field of laparoscopic surgery advances, we want to move with it and remain on the cutting edge of technology that will give patients a chance at the best outcomes and the quickest recovery time.”
Dr. Richard Link
To obtain a physician referral, call 713.790.3333 or visit methodisthealth.com.
The Methodist Hospital’s urology service ranks No. 10 on U.S.News & World Report’s “America’s Best Hospitals” list. Up six spots from last year, urology, which includes the treatment of prostate cancer, has ranked in the top 20 for 10 consecutive years.
