Pyeloplasty
Pyeloplasty is a reconstructive urological procedure that corrects pelviureteric junction (PUJ) obstruction — excising the obstructed segment and reconstructing a wide, unobstructed join between the renal pelvis and ureter — permanently relieving flank pain, protecting kidney function, and eliminating recurrent infections.
Overview
Pyeloplasty corrects PUJ obstruction — a congenital or acquired narrowing at the junction of the kidney's collecting system (renal pelvis) and the ureter — by excising the obstructed segment and creating a widely patent, funnel-shaped anastomosis between the spatulated ureter and the dependent part of the renal pelvis. The Anderson-Hynes dismembered pyeloplasty is the gold standard technique, now performed laparoscopically in most centres with a success rate exceeding 90%. The procedure permanently resolves the obstruction causing recurrent flank pain, progressive kidney dilatation, and impaired drainage that threatens long-term renal function.
Types of Pyeloplasty
The surgical technique of pyeloplasty is tailored to the specific anatomy of the PUJ obstruction and the presence of any crossing lower pole vessel.
- Anderson-Hynes Dismembered Pyeloplasty (excision and spatulated re-anastomosis — gold standard)
- Laparoscopic Dismembered Pyeloplasty (minimally invasive — current standard of care)
- Robot-Assisted Pyeloplasty (enhanced precision with da Vinci platform)
- Foley Y-V Plasty (for high insertion of ureter into renal pelvis without crossing vessel)
- Secondary Pyeloplasty (revision procedure for failed primary repair)
Risk Factors for PUJ Obstruction
PUJ obstruction has both congenital and acquired aetiologies that contribute to the narrowing at the pelviureteric junction.
- Congenital intrinsic aperistaltic ureteral segment — the most common cause
- Crossing lower pole vessel compressing the PUJ externally
- Secondary fibrosis from previous endopyelotomy, stone, or infection
- Previous ureteropelvic inflammation from stone migration through the PUJ
- Horseshoe kidney anatomy predisposing to PUJ obstruction
- Congenital ureteral folds or kinks at the pelviureteric junction
PUJ Obstruction Symptoms
These symptoms indicate pelviureteric junction obstruction requiring nuclear medicine functional assessment and specialist urological evaluation.
- Intermittent severe flank pain and loin tenderness — often worse after drinking large volumes (Dietl's crisis)
- Nausea and vomiting associated with severe intermittent flank pain episodes
- Haematuria after exercise or minor renal trauma
- Recurrent urinary tract infections from obstructed and stagnant upper tract urine
- Incidental discovery of hydronephrosis on ultrasound or CT performed for another reason
- Progressive hydronephrosis with impaired drainage on MAG3 renogram
- Flank pain in pregnancy from physiological ureteral dilatation worsening pre-existing PUJ obstruction
- Newly symptomatic PUJ obstruction in a previously asymptomatic patient with known hydronephrosis
Key Benefits
Discover the advantages of choosing our pyeloplasty services.
Definitive cure of PUJ obstruction in over 90% of patients with a single laparoscopic procedure
Laparoscopic approach provides equivalent success rates to open surgery with faster recovery
Relief from the severe recurrent flank pain episodes that significantly impair quality of life
Prevention of progressive hydronephrosis and renal parenchymal thinning from ongoing obstruction
MAG3 renogram at 3 months provides objective confirmation of successful obstruction relief
Clinical Features
The technology, techniques and clinical approach behind our pyeloplasty.
Pre-operative MAG3 renogram confirms obstructed drainage and adequate recoverable renal function
Anderson-Hynes dismembered technique excises the obstructed segment completely
Dependent pelvis anastomosis to the spatulated ureter creates the most gravity-dependent drainage
JJ ureteric stent splints the anastomosis providing urinary diversion during healing
Perianastomotic drain detects early anastomotic leak before any clinical deterioration
Preparation Instructions
After Pyeloplasty, expect mild ureteric colic and urinary frequency from the JJ stent for the 4 to 6 weeks until it is removed — prescribed alpha-blockers and anti-inflammatory analgesics manage this effectively. Attend the JJ stent removal cystoscopy at 4 to 6 weeks as scheduled and the MAG3 renogram at 3 months to confirm successful obstruction relief. Contact your urology team for fever, severe flank pain, inability to pass urine, or visible haematuria after discharge.
The Procedure
Step-by-step guide to what you can expect during your pyeloplasty procedure.
Pre-Operative MAG3 Renogram and CT Planning
Your urologist reviews the MAG3 renogram confirming the degree of obstruction and the percentage split renal function — confirming that the ipsilateral kidney has sufficient recoverable function to justify reconstruction — alongside CT urogram for anatomy and vessel planning.
General Anaesthesia and Lateral Positioning
General anaesthesia is administered and you are positioned in a modified lateral decubitus position. Three to four laparoscopic ports are placed and the retroperitoneum is entered for the standard laparoscopic dismembered pyeloplasty approach.
Renal Pelvis and PUJ Exposure
The ureter and renal pelvis are identified and carefully dissected free from surrounding tissue. The PUJ obstruction — whether intrinsic aperistaltic segment or extrinsic crossing vessel — is fully exposed before any division of tissue.
Anderson-Hynes Dismembered Pyeloplasty
The obstructed PUJ segment is excised, the ureter is spatulated on its lateral wall for 1 to 1.5 cm, and the dependent most inferior part of the renal pelvis is trimmed. The spatulated ureter is anastomosed to the trimmed dependent pelvis with interrupted absorbable sutures.
JJ Stent Placement and Anastomosis Completion
A JJ ureteric stent is positioned with its proximal curl in the renal pelvis and its distal curl in the bladder — providing ureteric splinting and urinary drainage during anastomotic healing. The anastomosis is completed with interrupted sutures and watertightness is confirmed.
Drain Placement and Recovery
A perianastomotic drain is placed to detect any early anastomotic leak. Port sites are closed and you are monitored in the urology ward. JJ stent removal by flexible cystoscopy is arranged at 4 to 6 weeks and MAG3 renogram at 3 months confirms drainage improvement.
What to Expect
Laparoscopic Pyeloplasty is performed under general anaesthesia and takes 2 to 2.5 hours. Three laparoscopic ports are placed, the PUJ is exposed, the obstructed segment is excised, the ureter is spatulated, and a widely patent funnel-shaped anastomosis is created between the dependent renal pelvis and the spatulated ureter over a JJ stent. The JJ stent remains in place for 4 to 6 weeks before cystoscopic removal. Success is confirmed with a post-operative MAG3 renogram at 3 months.
Frequently Asked Questions
Common questions about pyeloplasty.
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