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.
Colorado Comprehensive Pelvic Floor Center
The Colorado Comprehensive Pelvic Floor Center strives to provide compassionate, evidence-based care to patients with pelvic floor disorders. Our providers work closely to create an individualized diagnosis and treatment plan for each patient and may include minimally invasive to complex procedures.
Diagnosing pelvic floor disorders begins with a consult. We utilize state-of-the-art diagnostic tools to best evaluate your condition. Once an accurate diagnosis has been made, our experts collaborate to create an individualized treatment plan.
Pelvic floor conditions we treat
We offer multi-disciplinary care for a full spectrum of pelvic floor conditions, including:
- Chronic bladder infection
- Chronic pelvic pain
- Incontinence of stool
- Interstitial cystitis/painful bladder syndrome
- Overactive bladder
- Pelvic floor muscle spasms
- Pelvic pain
- Pelvic organ prolapse
- Urinary stress incontinence
- Urgency urinary incontinence
- Urinary retention
Risk factors and symptoms of pelvic floor disorders
Many factors can place a woman at risk for pelvic floor disorders. Childbirth, obesity, pelvic surgery or radiation, genetics and heavy lifting increase your risk for a pelvic floor condition. While pelvic floor disorders can become more common as you age, the symptoms are not normal. Talk to our team if you experience:
- Incontinence (leakage) of urine and/or stool
- Frequency of urination
- Painful urination
- Incomplete emptying of bladder
- Pain or muscle spasms in pelvic region
- Pressure in vagina or rectum
- Heavy feeling or bulge in vagina or rectum
- Chronic pelvic pain
- Painful intercourse
If you think you are suffering from a pelvic floor disorder, review the questions below to help you learn more about whether to seek care from our expert team.
- Do you experience difficulty doing household chores (cooking, laundry, housecleaning)
- Do you experience difficulty doing physical activities such as walking, swimming or other exercise?
- Do you have difficulty going to entertainment activities such as movies or a concert?
- Is it difficult traveling by car or bus for a distance greater than 30 minutes from your home?
- Do you have trouble participating in social activities outside your home?
- Do you have emotional problems (such as nervousness or depression)?
- Are you feeling frustrated?
Treatment for pelvic floor disorders
Treatment plans may be surgical or non-surgical. The following options are what we offer to help you back to a healthy, active lifestyle:
- Physical therapy
- Vaginal cones
- Pubovaginal sling (sling of tissue is placed under bladder and urethra for support)
- Tension-free vaginal tape sling (small piece of tape placed around the pubic bones under the urethra)
- Transobturator tape (permanent tape put in the vagina to sit under urethras)
- Pelvic organ prolapse repair
- Bladder neck suspension
- Colpocleisis (surgery to treat pelvic organ prolapse)
- Uterosacral or sacrospinous ligament fixation
- Sacrocolpopexy (repairs pelvic organ prolapse through the abdominals)
- Transurethral bulking
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.