Ureteral
(Upper Tract)
​Ureteral (upper tract) reconstruction is typically required to address kidney obstructions that extend to the bladder.
Types of Upper Tract Conditions
Ureteropelvic Junction Obstruction
Ureteropelvic junction obstruction (UPJO) is one of the most common causes of kidney drainage blockages. This condition refers to the obstruction of urine flow from the kidney pelvis to the ureter, which drains urine into the bladder. There are various causes for this blockage, including internal scar tissue, crossing renal vasculature, and kidney stones.
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Tulane Urology has pioneered robotic pyeloplasty since 2002, becoming one of the early departments in the country to define and refine this procedure. The da Vinci robot is utilized for this surgery. Your urologist will perform appropriate diagnostic imaging and functional studies of the kidney to determine the best management approach for UPJO.
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During the procedure, the blocked segment of the UPJO is excised, any stones are removed, and adjustments to the renal pelvis are made. The ureter is then reconnected to the kidney pelvis.
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Tulane Urology is proud to have initiated this procedure in the region, successfully treating both adults and children. Our peer-reviewed publications have laid the groundwork for this procedure, including adaptations for smaller pediatric patients.
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Additionally, Tulane Urology actively shares this knowledge by teaching optimal methodologies for pyeloplasty to other robotic surgeons at national and international urology symposia and seminars.
The arrow points to the blockage, which drains and slows the drainage of urine from the kidney.
Robotic view of crossing renal vasculature blocking urine drainage.
Robotic removal of stone from the renal pelvis.
Ureteroureterostomy
Ureteral strictures can occur for several reasons, leading to blockages in the ureter (the tube that drains urine from the kidney into the bladder). Common causes include multiple episodes of kidney stones, instrumentations of the urinary tract, strictures resulting from radiation for malignancies, and trauma such as gunshot wounds and surgical injury to the ureter.
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Early diagnosis and repair are crucial. In some cases, a nephrostomy tube may be placed to assist with drainage.
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The key to diagnosis and treatment is determining the exact location and length of the stricture (whether it is a short or long segment) and identifying the underlying cause (radiation, trauma, or previous surgeries). This information helps formulate a plan to remove the stricture and ensure normal urine flow from the kidney to the bladder.
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Once a diagnosis is made, the procedure involves excising or removing the scar tissue in the ureter and realigning it to restore normal drainage.
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At Tulane Urology, we specialize in robotic procedures for managing these strictures, including:
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Ureterostomy: Connecting the two ends of the ureter after excising fibrous tissue.
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Ureteral reimplantation: If the stricture is close to the bladder.
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Bladder Boari flap: A reconstructive technique using a piece of the bladder to bypass the strictured segment.
Since 2002, Tulane Urology has been at the forefront of treating various ureteral pathologies.
Right ureteral strictures between the arrows.
Multiple ureteral strictures are caused by multiple instrumentations in the ureter for a patient with recurrent kidney stones. This is a complex ureteral stricture that requires master planning and experience in management.