Pyeloplasty

Pyeloplasty is a surgical procedure to correct an obstruction at the ureteropelvic junction (UPJ), the area where the renal pelvis meets the ureter. The aim is to restore normal urine drainage from the kidney, relieve hydronephrosis, and preserve or improve renal function. It is commonly performed for UPJ obstruction, which can be congenital or acquired, and may present with flank pain, recurrent infections, or impaired kidney function.

Evaluation typically includes imaging studies such as ultrasound to assess hydronephrosis, diuretic renography to measure drainage and split renal function, and CT or MR urography to define anatomy. Endoscopic or cystoscopic assessment may be used in planning. Treatment decisions depend on alignment of symptoms, degree of obstruction, renal function, and anatomical factors.

Open pyeloplasty, particularly the Anderson–Hynes dismembered technique, is a traditional gold standard that involves transecting and reattaching the UPJ to widen the junction and restore urine flow, often with a temporary stent. Alternatives include non-dismembered pyeloplasty techniques such as Fenger plasty, which preserve the UPJ without complete disconnection. Minimally invasive approaches—laparoscopic pyeloplasty and robotic-assisted laparoscopic pyeloplasty—have become common, offering similar success with typically shorter recovery. Endopyelotomy, an endoscopic incision of the UPJ, is less commonly used and mainly considered for select cases with favorable anatomy or higher surgical risk.

Outcomes are generally favorable, with success rates exceeding 90% in experienced centers across open and minimally invasive techniques. Postoperative stents are common. Hospital stays are usually shorter with laparoscopic or robotic approaches. Complications can include urine leakage, infection, hematoma, or restenosis, though these are relatively uncommon in appropriate candidates. Pyeloplasty is applicable to both pediatric and adult UPJ obstruction, with technique choice guided by patient factors and surgeon expertise.