Pyeloplasty (Surgery for PUJ Obstruction)
Repair of the narrowing where the kidney drains. The dangerous feature of this condition is that it can progress without pain: the kidney quietly dilates and loses function. The aim is to preserve the kidney.
Last medically reviewed: October 4, 2026 — Assoc. Prof. Dr. Müslüm Ergün
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- Procedure time
- 2–4 hours
- Anesthesia
- General anaesthesia
- Hospital stay
- 2–3 nights
- Stay in Türkiye
- 7–10 days
- Return to work
- 2–4 weeks
- Flight clearance
- After review; flying with a stent is possible
About the condition
Pelviureteric junction (PUJ) obstruction is a narrowing where the renal pelvis joins the ureter. Urine cannot drain adequately from the kidney, the pelvis dilates (hydronephrosis), and over time renal function can decline.
THE MOST IMPORTANT FEATURE OF THIS CONDITION: IT MAY NOT HURT. Where obstruction develops slowly the kidney dilates quietly and the person may feel nothing at all. The inference "I have no pain, so there is no problem" is therefore dangerous here. In some patients, flank pain that appears after drinking a large volume of fluid or alcohol is characteristic.
THE PRESENCE OF A NARROWING IS NOT IN ITSELF A REASON TO OPERATE. Dilatation on imaging does not always mean obstruction; some kidneys look full but drain adequately. What is needed for a decision is evidence that the obstruction is actually affecting the kidney. The study that shows this is the renogram: it measures both that kidney's share of total function and whether the tracer drains.
THE SITUATIONS THAT DRIVE THE DECISION are: reduced function of that kidney on the renogram or a declining trend on follow-up, clearly impaired drainage, recurrent episodes of pain, stone formation associated with the narrowing, and recurrent urinary infection.
In pyeloplasty the narrowed segment is removed and the renal pelvis and ureter are rejoined as a wide, funnel-shaped anastomosis. In some patients a vessel crossing in front of the ureter contributes to the obstruction; the join is then repositioned in front of that vessel.
Who is it suitable for?
May be suitable
- Patients with reduced function of that kidney on the renogram, or a declining trend on follow-up
- Patients with clearly impaired drainage
- Patients with recurrent flank pain — pain appearing after a large fluid intake is characteristic
- Patients who have developed a kidney stone alongside the narrowing
- Patients with recurrent urinary infections
- Patients whose previous endopyelotomy or pyeloplasty has failed (redo)
- Patients found to have a crossing vessel
May not be suitable
- Patients with dilatation on imaging but normal drainage and function on the renogram: surgery is not required and they are followed
- Patients with untreated urinary infection: the infection is treated first
- Patients whose kidney function is lost to an advanced and irreversible degree, in whom repair will not deliver the expected benefit; a different plan is made
- Patients whose general condition is unsuitable for laparoscopic or robotic surgery, in whom the approach is reconsidered
Technology used
- CT urography — shows the anatomy and any crossing vessel
- Renogram (MAG3 or similar) — the basis of the decision to operate; it measures function and drainage together
- Ultrasound — for following hydronephrosis
- Robot-assisted dismembered pyeloplasty
- Laparoscopic and open techniques
- Removal of an associated kidney stone in the same session where required
- Placement and removal of a JJ stent
Surgeon's experience
Verifiable information
- Redo (repeat surgery) rate
- A substantial proportion of cases are redo repairs following a failed procedure or iatrogenic injury elsewhere.
- Complex case definition
- Crossing vessels, associated kidney stones, anatomical variants such as horseshoe kidney, and redo cases fall within the complex category.
- Advanced technique used
- Robot-assisted dismembered pyeloplasty; reconstruction in dense scar tissue in redo cases.
- Surgeon's experience
- Assoc. Prof. Dr. Müslüm Ergün121270
Step-by-step journey
- Remotely
Review of your file
Your CT urography images and your RENOGRAM are reviewed. A sound decision cannot be made without a renogram; dilatation seen on ultrasound alone is not enough.
- Days 1–2
Arrival and work-up
Examination, completion of any missing imaging, blood and urine tests, anaesthetic assessment. If the urine culture grows an organism, surgery is postponed.
- Day of surgery
Repair
The narrowed segment is removed and the join reconstructed with a wide opening. Where there is a crossing vessel, the join is brought in front of it. An associated stone can be removed in the same session.
- Days 2–3
Discharge
Most patients go home at this point. A JJ stent remains inside, and the symptoms it causes are explained.
- Before you fly
Review
Wound check and flying clearance. Flying with a stent is usually not a problem, but who will remove it and where must be planned in writing.
- Weeks 4–6
Stent removal
A short procedure. It can be done in your own country, but confirm in advance that your local urologist has agreed to it.
- Months 3–6 and beyond
Function follow-up
Drainage and renal function are followed with a repeat renogram and ultrasound. Success in this operation is measured by long-term drainage, not by the operation itself.
Method comparison
| Criterion | Open | Laparoscopic | Robotic |
|---|---|---|---|
| Incision | One large incision | Small incisions | Small incisions |
| Suture precision | Good | Technically demanding | High |
| Recovery | Longer | Short | Short |
| Suitability for redo and complex cases | In selected cases | Limited | Favoured |
| Hospital stay | 3–5 nights | 2–3 nights | 2–3 nights |
| With a crossing vessel | Feasible | Feasible | Easier dissection |
What distinguishes this repair is that it requires a fine, watertight suture line, which is why suture precision weighs heavily in the choice. The method is nonetheless individualised to the type of narrowing, previous surgery and anatomy. Saying "it must be robotic" does not replace that assessment.
Risks
- STENT SYMPTOMS: frequency, flank discomfort and blood in the urine are usual and resolve on removal. This is what surprises patients most; knowing it is expected makes the period considerably easier
- Urine leak at the join — usually managed with the stent and a drain
- RECURRENCE OF THE NARROWING: more likely in redo cases and where there is dense scar tissue
- Bleeding and infection
- Febrile urinary infection — particularly if the pre-operative culture was not clear
- Injury to adjacent organs — uncommon
- Renal function not improving as hoped: the operation restores drainage but does not recover function already lost. This must be discussed plainly before surgery
- Clot risk after pelvic surgery combined with a long flight
Alternatives
- Observation — for patients with dilatation on imaging but preserved function and drainage on the renogram. Observation means imaging; absence of symptoms alone is not enough
- Endopyelotomy — cutting the narrowing from inside; possible in selected short strictures but with a higher recurrence rate than pyeloplasty
- Robot-assisted pyeloplasty — widely preferred for a repair that demands suture precision
- Laparoscopic pyeloplasty
- Open pyeloplasty — in selected cases, particularly complex redo surgery
- Nephrectomy — only for a kidney that has lost all function and is a source of symptoms or infection, as a last resort
Recovery
First 48 hours
Pain is controlled with medication. Early walking matters both for bowel recovery and to reduce clot risk.
Week 1
Tenderness at the port sites is usual. Avoid lifting. A little blood in the urine, particularly after activity, is expected with a stent in place.
With the stent (4–6 weeks)
Frequency, flank discomfort and a tugging sensation on voiding are usual and resolve on removal. Seek help immediately for fever, shivering or inability to pass urine.
After stent removal
A marked reduction in symptoms is expected. Some stinging on passing urine may persist for a few days.
Months 3–6
A repeat renogram or ultrasound assesses whether drainage has improved. Hydronephrosis not disappearing entirely does not always mean failure; what matters is that drainage is restored.
Long term
Regular follow-up continues. Return of flank pain or a febrile infection should prompt assessment without delay.
Frequently asked questions
My ultrasound shows dilatation of the kidney — must I have surgery?
No, dilatation alone is not a reason to operate. Some kidneys look full but drain adequately. A decision requires evidence that the obstruction is actually affecting the kidney, and the study that shows this is the renogram. A decision made without one is incomplete.
I have no pain, so there is no hurry — is that right?
That assumption is dangerous in this condition. Slowly developing obstruction may be painless while the kidney quietly dilates and loses function. If you have a known PUJ obstruction, continue follow-up with renography and imaging even without symptoms.
I get flank pain after drinking a lot of water — what does that mean?
That is a characteristic finding. When fluid load rises the kidney must drain more; the narrowing prevents it, pressure builds and pain follows. Do tell your doctor about this, because it points towards the diagnosis.
Can my kidney be saved?
That is exactly the aim. To be honest, though, the operation restores drainage; it does not recover function already lost. That is why deciding early matters. How much function can be preserved is assessed on the renogram.
Is robotic better than open?
This repair requires a fine, watertight suture line, so suture precision matters and the robotic approach is favoured for that. The method is nonetheless chosen according to the type of narrowing, any previous surgery and your anatomy. What matters is not which device is used but that the join is wide and tension-free.
I had an endopyelotomy or pyeloplasty before and it recurred. What can be done?
A redo repair is possible in most cases, but scar tissue from the previous procedure makes it harder than a first operation and the success rate is lower. That should be said plainly. Your previous operation note is decisive in planning; a plan made without knowing which technique was used is incomplete.
How long does the stent stay and is it very uncomfortable?
Usually 4–6 weeks. Frequency, flank discomfort and a tugging sensation on voiding are usual and resolve on removal. This is what surprises patients most, which is why we say it in advance: the discomfort is expected, not a complication.
Can I fly with the stent, and who removes it?
Flying with a stent is usually not a problem. What must be planned is who will remove it and where. It is a short procedure and can be done in your own country, but your local urologist must have agreed to it beforehand. Settle this before you fix your travel dates.
Will the hydronephrosis disappear completely after surgery?
Not always, and that does not necessarily mean failure. A renal pelvis that has been dilated for a long time may not return to its former size even once drainage is restored. What is assessed on follow-up is not shrinkage of the pelvis but restoration of drainage — which is why a renogram is more informative than an ultrasound here.
What should I send before coming?
The CT urography images themselves (not only the report), YOUR RENOGRAM RESULT, any previous operation notes, renal function tests, urinalysis and culture, your medication and your other medical conditions. If there is no renogram, one will be requested first: without it the indication for surgery cannot be assessed properly.
Scientific sources
This page is for general information only and is not a substitute for medical advice.
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