Robotic pyeloplasty for UPJ obstruction.
A definitive, minimally invasive reconstruction of the kidney's natural drainage system. One operation, ~95% durable success rate, three small incisions.
What it is
The ureteropelvic junction (UPJ) is the funnel where urine leaves the kidney and enters the ureter. When this junction is narrowed — congenitally in most adults who present with it, or by a crossing blood vessel — urine backs up into the kidney, causing flank pain, infections, stones, and sometimes silent loss of kidney function.
Robotic pyeloplasty removes the narrowed segment and reconstructs a wide, freely-draining new junction. It is performed through small abdominal incisions using the da Vinci platform.
Symptoms that lead to a pyeloplasty conversation
- Recurrent flank or upper-abdominal pain, often after fluid intake
- Recurrent kidney infections
- Kidney stones forming in a poorly-draining kidney
- Worsening function on a renal scan
- An incidental finding of hydronephrosis on imaging done for another reason
The workup
The two confirmatory tests are usually a MAG-3 (Lasix) renal scan to demonstrate obstruction and split function, and a CT urogram or MRI to map the anatomy and rule out a crossing vessel. For symptomatic patients with documented obstruction, pyeloplasty is the standard of care.
The operation
Four or five small incisions. Operative time about 90 minutes under general anesthesia. The narrowed segment is removed, any crossing vessel is repositioned, and the new wide junction is sewn together over a temporary internal ureteral stent that stays in place for 4 to 6 weeks. Pyeloplasty is typically same-day surgery — most patients go home the same day.
Recovery and outcomes
- Same-day surgery — most patients go home the same day
- Desk work: 1–2 weeks
- Full physical activity: 4 weeks
- The internal stent is removed in a brief office procedure at 4–6 weeks
- Long-term success — defined as resolution of obstruction and symptoms — is around 95%
Risks worth knowing about
- Failure of the reconstruction — uncommon, may require revision or endoscopic treatment
- Urine leak — usually self-resolves with the stent in place
- Stent discomfort during the 4–6 week period it is in
- Bleeding, infection, and the usual risks of an operation under general anesthesia