The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on laparoscopic pyeloplasty.
If the transition from the renal pelvis to the ureter is narrow, the urine will not drain easily and backs up causing dilatation of the collecting system proximal (behind) to that point and enlargement of the renal pelvis. This dilatation of the collecting system is referred to as hydronephrosis. UPJ obstruction is usually congenital, but may also be acquired (i.e. secondary to other disease processes or previous instrumentation).
A pyeloplasty is a surgical procedure that is indicated for a ureteropelvic junction (UPJ) obstruction. The UPJ is the portion of the collection system that connects the renal pelvis (the larger collecting portion of the kidney that is funnel shaped and tapers down to the ureter) to the ureter. The standard intervention for ureteropelvic junction obstruction is open pyeloplasty.
Many individuals with a UPJ obstruction do not realize they have this condition until later in life, when the poorly flowing urine becomes infected, or they begin developing symptoms such as pain.
Although different types of pyeloplasty operations have been described, the ultimate goal is to remove the narrowed portion of the UPJ, refashion the renal pelvis, and attach it to the ureter in a way to allow for easy drainage of urine down the ureter. There are different ways to approach the kidney to perform the operation. These include via a flank incision, subcostal (under the rib) incision, transabdominal approach, or even sometimes through an incision in the back.
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.