Pyeloplasty 

Causes, Symptoms, and Diagnosis

Congenital causes of UPJ obstruction include narrowing of the UPJ itself and structural anomalies in kidney positioning (horseshoe kidney, malrotation, or pelvic kidney). Acquired cases (non-congenital) can stem from injury or prior surgery, trauma or scar tissue, kidney stones, chronic infections or inflammation, or tumor compression.

The type of symptoms patients experience varies depending on age and severity. Some people have no symptoms at all, especially babies, while others experience:

• Pain in the side (flank), back, or abdomen
• Blood in the urine
• Nausea or vomiting
• Recurrent urinary tract infections
• Swelling of the kidney (hydronephrosis)
• Reduced kidney function

UPJ obstruction in infants is often detected during a prenatal ultrasound that shows significant fluid buildup in the fetus’s kidneys.

Doctors use a combination of lab tests and imaging studies to confirm the diagnosis and assess kidney function:

• Blood and urine tests to evaluate kidney health
• Ultrasound to detect swelling of the kidney
• CT urogram, a non-invasive X-ray test that creates detailed cross-sectional image “slices” and combines them into a 3D view
• MRI urogram for detailed anatomic and functional imaging
• Nuclear renal scan, which uses a small amount of radioactive tracer to evaluate kidney function, blood flow, and urine drainage
• Cystoscopy with retrograde pyelogram, an outpatient procedure using a small camera to examine the bladder and contrast dye with X-ray imaging to identify blockages or abnormalities

Functional studies help define kidney function and drainage and are used to diagnose an obstruction. Diuretic renography (MAG3 scan) and magnetic resonance urography (MRU) are functional studies that are commonly used both pre- and post-operatively.

The decision to utilize a procedure type will depend on the age of the patient and the severity of the obstruction and will be discussed between the doctor and the patient or the patient’s caregivers.

Numbing medicine and distraction techniques are additional comfort measures that can help lessen anxiety, especially in small children.

The procedure usually takes two to four hours. During this time, the patient is positioned, structures are identified and dissected, narrowing/blockage is removed, the healthy ureter is reconnected to the kidney (anastomosis), alterations may be performed to widen the connection, any kidney stones present are removed, a temporary ureteral stent is placed to support healing, and occasionally drains are inserted to remove excess fluid. A ureteral stent is usually left in place for several weeks, although they may be removed after approximately two weeks in small children.

Whether open or laparoscopic surgery is performed, a hospital stay of 1 day is all that is required for observation. Pain is controlled with the use of oral and/or IV medications, and some patients could experience bladder spasms due to the stent.

No strenuous activity is allowed for 4 to 6 weeks. Parents are advised to do their best to limit children to quiet activities, avoiding sports, swimming, and biking for at least four weeks or until the stents are removed.

Most patients start recovery on a liquid diet with a gradual return to their normal diet, and the surgical team will advise each patient on their unique dietary needs. Follow-up care will also be coordinated with the surgical team to remove catheters and stents shortly after surgery and monitor kidney dilation in the months following the procedure.

Georgia Urology’s pediatric providers are at the forefront of managing urinary tract disorders in children and adolescents – all of whom are 2025 “Top Docs” in Atlanta. We also serve as the exclusive urologists for Children’s Healthcare of Atlanta, and our program is consistently ranked among the top 10 in the nation by US News and World Report. From initial diagnoses to second opinions, we will help you find solutions with expertise and unparalleled care. 

FAQs

What is pyeloplasty, and why is it done?

It is a surgical procedure to remove a ureteropelvic junction (UPJ) obstruction or narrowing in order to restore proper kidney drainage, preserving function and reducing symptoms.

Can pyeloplasty be done in infants?

Yes, pyeloplasty is commonly performed in infants and is considered safe and effective when done by an experienced pediatric urologist. UPJ obstruction can sometimes be identified before birth through prenatal ultrasound, and after the baby is born, doctors monitor kidney function and drainage to determine whether surgery is necessary.

How long does surgery and recovery take?

Surgery typically lasts 2 to 4 hours, and most patients recover within a few weeks. Full healing may take longer.

What are the risks and benefits of robotic vs open surgery?

The choice also depends on the patient’s age, unique anatomy, the surgeon’s experience, and the complexity of the obstruction. Your surgical team will recommend the approach that is safest and most effective for your situation.

Will I need a stent? How is it managed?

To support healing, most patients receive a temporary internal ureteral stent that is removed within a few weeks during a follow-up visit.

Will hydronephrosis go away completely?

Not always. Drainage improves, and there can be some degree of kidney dilation even after successful surgery for some patients. This is often normal and reflects stretching of the renal pelvis tissues, not persistent blockage.

Who is a candidate for pyeloplasty?

Patients with symptomatic or functionally significant UPJ obstruction that is either congenital or acquired.

How will I know if the surgery worked?

Improvement in symptoms and follow-up imaging showing better drainage are the main indicators of success.

What complications should I watch for, and when should I call my doctor?

Most people recover without serious issues, but it is important to know what may signal a complication. If you notice fever, severe or worsening pain, persistent nausea or vomiting, decreased urine output, difficulty urinating, bright red blood or clots in the urine, foul-smelling or cloudy urine, or signs of infection such as redness, swelling, warmth, or drainage at the surgery site, contact your doctor.

Some mild symptoms, such as light blood in the urine, mild discomfort, or bladder irritation from the stent, are common early in recovery. Symptoms that worsen instead of improve should be evaluated.

Resources:

1. O’Sullivan, N. J., & Anderson, S. (2023). Pelviureteric junction obstruction in adults: A systematic review of the literature. Current urology, 17(2), 86–91. https://doi.org/10.1097/CU9.0000000000000154.
2. González, S. T., Rosito, T. E., Tur, A. B., Ruiz, J., Gozalbez, R., Maiolo, A., Tavares, P. M., Gorgen, A. R. H., de Kencht, E. L., Madarriaga, Y. Q., Weller, S., Tobia, I. P., Castellan, M., & Corbetta, J. P. (2022). Multicenter comparative study of open, laparoscopic, and robotic pyeloplasty in the pediatric population for the treatment of ureteropelvic junction obstruction (UPJO). International braz j urol : official journal of the Brazilian Society of Urology, 48(6), 961–968. https://doi.org/10.1590/S1677-5538.IBJU.2022.0194.