Pyelotomy

Pyelotomy is a surgical procedure involving a deliberate incision into the renal pelvis, the upper part of the collecting system inside the kidney. The operation is performed to relieve obstruction, gain access to the intrarenal collecting system, or remove stones. Pyelotomy can be performed through several approaches, including open pyelotomy, percutaneous pyelotomy, and endopyelotomy (an endoscopic incision of the ureteropelvic junction).

Indications for pyelotomy include ureteropelvic junction obstruction, stones confined to the renal pelvis or calyces that require direct access, calyceal diverticula, tumors of the pelvicalyceal region, or as part of reconstructive procedures such as pyeloplasty.

Techniques vary by approach. Open pyelotomy involves exposing the kidney and making a longitudinal incision in the renal pelvis over the ureteropelvic junction to remove obstructing tissue or stones, followed by closure of the pelvis. Percutaneous pyelotomy uses image-guided access through a flank tract to reach the renal pelvis, incise it as needed, and extract stones. Endopyelotomy employs a ureteroscope to incise the UPJ from within the collecting system, typically using a laser or cold knife, avoiding an external incision.

Outcomes and risks depend on the underlying problem and approach. Open and percutaneous pyelotomies generally provide reliable relief but carry risks of bleeding, urine leakage, infection, injury to renal tissue or adjacent structures, and stricture formation at the incision site. Endopyelotomy avoids external wounds but may have lower success rates for long or complex obstructions.

Pyelotomy is related to, but distinct from, pyeloplasty, which reconstructs the ureteropelvic junction, and from nephrolithotomy or pyelolithotomy, which remove stones without incising the pelvis itself.