Urologic care in Denver, CO
Swedish Medical Center offers multi-disciplinary, coordinated care for urologic conditions, including pelvic floor disorders, and less invasive robotic-surgery.
Understanding ureteral conditions
A ureter disorder or ureteral condition can refer to:
- A congenital condition where two ureters form on the same kidney
- A blockage between the kidney and ureter that prevents urine from leaving the kidney
- A blockage that occurs between the ureter and the bladder
When passage of urine is blocked in any of these ways, this can cause pyelonephritis, which is an inflammation of the kidney due to infection, loss of renal function or kidney stones.
Surgery for ureteral conditions
There are multiple ureteral conditions that may require surgery. Some of the most common ureteral conditions that might require surgery include:
- An injury resulting from an external trauma (like a car accident or other physical injury)
- Scarring or damage from a previous surgery, typically a hysterectomy or ureteroscopy
- Radiation sickness, typically from radiation therapy when treating cervical cancer
- Retroperitoneal fibrosis from inflammation or autoimmune disease
- Ureteral reflux
Ureteral injuries are not often immediately detected. These ureteral injuries can potentially be life-threatening or result in permanent damage to a kidney, potentially requiring a complete removal of the affected kidney. Because of this, it is important to repair ureteral injuries and conditions through surgery.
Robot-assisted surgery for ureteral repairs
At Swedish, surgeons employ the assistance of the da Vinci® robotic surgery system to perform ureteral repairs. This advanced, minimally invasive robotic technology allows surgeons to make small, precise incisions to the surgical area. It also provides improved dexterity and increased control of motion, allowing for less blood loss, less pain and reduced risk of infection.
Ureteral reimplant surgery
Ureters are tubes that carry urine from the kidney to the bladder. The ureter is designed so that urine enters the bladder, but does not flow back up into the kidney. Vesicoureteral reflux is a condition where the ureter enters the bladder in an abnormal way, which causes the urine to flow back towards the kidney. When urine flows back toward the kidney, this can cause kidney damage. Ureteral reimplant surgery fixes vesicoureteral reflux. The surgeon “reimplants” the ureter, fixing the connection to the bladder.
People with vesicoureteral reflux commonly have UTIs. The symptoms of a urinary tract infection in adults include:
- A persistent feeling of needing to urinate
- A burning sensation while peeing
- Blood in the urine or strong-smelling urine
- Abdominal pain or pain near the abdomen
In children, signs of a UTI can be different. Infants may have fever, diarrhea or a lack of appetite. In older children, signs include bed-wetting, constipation or uncontrollable bowel movements, high blood pressure, protein in the urine or kidney failure.
Robotic pyeloplasty is a surgical procedure to treat a ureteral condition called a ureteropelvic junction obstruction (UPJ obstruction). A UPJ obstruction refers to a blockage where the pelvis and ureter meet. This procedure can correct the obstruction so urine can pass from the kidney into the ureter.
A robotic laparoscopic pyeloplasty typically takes two to three hours. The surgeon places a stent inside the ureter, which is used to bridge the pyeloplasty repair and help drain the kidney. The stent remains in the body for four weeks, after which the patient visits the doctor to remove.
What causes a ureteral obstruction?
When there is a blockage or obstruction, the narrowing of the tube causes dilation of the kidney. Because the urine cannot pass from the kidney to the ureter, pressure builds up inside the renal pelvis. This can cause pain in the kidneys, kidney stones or negatively impact the function of the kidneys over time. In the majority of cases, a person is born with predisposition to a UPJ obstruction. In a small number of patients, a UPJ obstruction develops over time due to things like trauma, body growth, scar tissue or ureteral kinks.
How common is a UPJ obstruction?
UPJ obstructions occur in roughly one in 1,500 children. Typically, these obstructions develop prenatally as the kidney is forming. In adults, an obstruction is far less common. However, one can potentially occur due to kidney stones, a prior surgery or disorders that lead to inflammation of the upper urinary tract.
Robotic simple prostatectomy
A prostatectomy is a surgery that involves the removal of the prostate. In men, when the prostate gland becomes large enough to interfere with the urethra, this condition is known as benign prostatic hyperplasia (BPH), or an enlarged prostate. The surgery does not remove the entire prostate, it only removes the section of the prostate that is obstructing the flow of urine to the urethra.
An enlarged prostate can cause several health issues in men, such as problems urinating, frequent urinary tract infections (UTIs), bladder issues, bleeding from the prostate, bladder stones or kidney damage. To treat, a doctor may recommend diet or lifestyle changes before determining whether a patient needs surgery.
How do I prepare for a robotic simple prostatectomy?
Prior to surgery, a doctor will likely administer a blood test to check for other medical conditions, do an ultrasound of the prostate gland and surrounding organs, perform a biopsy of the prostate and get a CT scan or MRI of the abdomen and pelvis. We perform prostatectomies using the minimally invasive da Vinci® robotic surgical system.
Patients should tell their doctor about what medications they are taking and if they are allergic to any medications. The day before surgery, do not eat or drink anything after midnight. The surgeon may ask the patient to do an enema beforehand.
We provide urinary diagnostic imaging through our in-house imaging department. A cystogram examines the urinary bladder with a form of X-ray (fluoroscopy) and a water-soluble contrast agent. A cystogram shows the shape and position of the bladder and is performed to assess bladder injury after trauma to the pelvis.
A cystourethrogram and voiding cystourethrogram are slight variations on the cystogram procedure and can also be useful in diagnosing the cause of recurrent UTIs, urinary incontinence or structural abnormalities.