Laparoscopic Pyeloplasty

Laparoscopic pyeloplasty is the minimally invasive surgical treatment of choice for ureteropelvic junction obstruction (UPJO). UPJO is the most common cause of congenital hydronephrosis in children and a frequent etiology of obstructive uropathy in adults. Causes include intrinsic stenosis (95%), crossing aberrant lower-pole vessel (15-30%), and high ureteral insertion. The condition causes progressive renal pelvic dilation, parenchymal thinning, and gradual functional loss.

Surgical technique: Anderson-Hynes dismembered pyeloplasty is the gold standard. Through transperitoneal or retroperitoneal access with 3-4 trocar ports, the UPJ region is exposed, obstructed segment is excised, the ureter is spatulated, and a watertight, tension-free anastomosis is created over a JJ stent. Bypass anastomosis is preferred when crossing vessels are present. Robotic-assisted approach allows easier suturing.

Indications: symptomatic UPJO (pain, recurrent infection), differential renal function <40%, progressive functional loss, increasing hydronephrosis, kidney stone formation. Preoperative evaluation: USG, MAG3 dynamic renal scan (washout pattern), CT urography, MRI urography. Postoperative follow-up: JJ stent removal at 4-6 weeks, MAG3 at 3 and 6 months.