Q&A Topic: Persistent UTIs? Pain in Your Side? You Might Have a Urinary Tract Abnormality

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Warren Bromberg, MD, FACS

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Q:  What are congenital abnormalities of the urinary tract?

A:  Though present at birth, these common internal abnormalities are often discovered in adulthood because of a persistent symptom.  Symptoms may include long-term urinary incontinence, a swollen abdomen, pain in the side or back, and urinary tract infections. As these are common symptoms, people often wait years, even decades, to have them checked by a doctor, hence the often-late discovery of the underlying abnormality.

Q: What are examples of these abnormalities?

A:Ureteropelvic junction obstruction. An abnormal narrowing of the top of the ureter, the long tube that drains urine from the kidney to the bladder, prevents the kidney from draining, causing it to balloon with urine.

The fix: Disconnect the ureter, widen it, and reattach it. Ectopic ureter.  This involves the abnormal insertion of the lower end of the ureter into an organ other than the bladder. In males, the malformation can obstruct the kidney, causing it to swell. In females, the tube can empty into the uterus, vagina or even the rectum, causing a constant leaking of urine.

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The fix: Detach the tube’s end from the wrong organ and connect it to the bladder.  Bladder diverticulum is an abnormal pouch extending off the bladder. Rather than draining properly, urine goes into the pouch and stays there, often causing infection.

The fix: Remove the pouch and close the muscular weakness in the bladder that permitted the pouch to develop.

Q: How does robotic surgery offer major advantages in these cases?

A: Fixing urinary tract abnormalities requires much internal reconstruction and repair. Robotics offers the surgeon unparalleled viewing ability within the body as well as dexterity, both ideally suited to moving organs and tissue in the most delicate and precise way. In many of these cases, blood vessels are in abnormal locations and entangled. Robotic technology’s unique addition of fluorescent imaging provides a visual roadmap that lets the surgeon accurately sort out the vessels. In addition, the tiny incisions used in robotics — unlike the large incisions traditionally used in these complex surgeries — are all that’s needed, as nothing is being removed from the body and the surgeon only needs access: the ability to get in with miniaturized instruments and get out.

Q: How does robotic surgery improve results post-surgery?  

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A: The procedures traditionally used to correct these abnormalities were very major surgeries with up to two large incisions and considerable recovery time. Robotics offers a minimally invasive approach and dramatically faster recovery. Though complex, this surgery now typically involves merely overnight hospitalization rather than a hospital stay of seven to ten days. Small incisions mean less pain, lower risk of infection, faster mobility post-surgery (always beneficial), and resumption of normal activities within two to three weeks. Robotic surgery is a multidisciplinary team effort, so if you’re interested in it for a urological abnormality, be sure to ask about the institution’s experience and the specialized training of all team members.

Learn More About Dr. Bromberg
Chief, Urology
Director, Center of Excellence, Institute for Robotic and Minimally Invasive Surgery
Director of Prostate Program
Northern Westchester Hospital

Northern Westchester Hospital is a proud member of Northwell Health.

Read Past Topics from Dr. Bromberg: 
Prostate Cancer 
Incontinence In Women
Kidney Stones
Bladder Cancer
Male Sexual Dysfunction 
Over 50? Difficulty Urinating? You May Need Treatment for an Enlarged Prostate
Kidney Cancer

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