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Updated: Aug 23, 2026
Transmesenteric Laparoscopic Pyeloplasty in Trendelenburg Position for Horseshoe Kidney with Hydronephrosis
Published on: July 8, 2025
McMaster experience with laparoscopic pyeloplasty
Abdullatif Hussain1, Paul Whelan, Kevin Piercey
1Department of Surgery (Urology), McMaster University, Hamilton, Ontario, Canada.
Purpose:
Laparoscopic pyeloplasty has been developed as a minimally invasive alternative to open pyeloplasty for the treatment of ureteropelvic junction obstruction (UPJO). Several series have been published with similar success rates for the two procedures. We present our initial experience with laparoscopic pyeloplasty.
Material And Methods:
A retrospective review of 29 consecutive patients (mean age 37 years) who underwent Laparoscopic dismembered Hynes-Anderson pyeloplasty in our institution between January 2001 to April 2003 was performed. All patients had flank pain with radiologic findings consistent with ureteropelvic junction obstruction and impaired drainage on diuretic renal scan. Patients were assessed at 6 weeks with an ultrasound and assessment of pain, then an intravenous pyelogram (i.v.p.) and diuretic renogram were completed at 6 months along with a repeat clinical assessment.
Results:
Twenty-nine patients underwent the procedure with one patient converted to an open procedure due to difficulties with the anastomosis. Mean operating time was 225 minutes, which decreased with experience. Mean blood loss was 50 cc and no patient required transfusion. Mean hospital stay was 2.5 days. Mean follow-up was 12 months. Twenty-six patients had complete resolution of their pain and an improvement on ultrasound was demonstrated, but only six patients showed improvement in function on i.v.p. or renogram at 6 months. In five patients with 25% or less differential renal function preoperatively, the function was worse or negligible despite complete resolution of symptoms. One patient developed stent migration requiring repositioning and another developed calcification on the distal end of the stent requiring cystolithalopaxy prior to stent removal.
Conclusions:
In our experience, laparoscopic pyeloplasty offers excellent symptomatic relief in a minimally invasive fashion with low morbidity for adult patients with ureteropelvic junction obstruction. In patients with borderline function (25% or less) preoperatively and with a normal functioning contralateral kidney, nephrectomy should be a consideration.
Insights
Laparoscopic pyeloplasty provides effective pain relief for ureteropelvic junction obstruction (UPJO) with minimal invasiveness. Consider nephrectomy for patients with borderline renal function.
Area of Science:
- Urology
- Minimally Invasive Surgery
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of flank pain.
- Laparoscopic pyeloplasty offers a minimally invasive alternative to open surgery.
Purpose of the Study:
- To evaluate the initial experience and outcomes of laparoscopic pyeloplasty for UPJO in adult patients.
- To assess the efficacy and safety of this minimally invasive approach.
Main Methods:
- Retrospective review of 29 adult patients undergoing laparoscopic dismembered Hynes-Anderson pyeloplasty.
- Patients were assessed for pain, imaging (ultrasound, IVP), and renal function (diuretic renogram) preoperatively and postoperatively.
Main Results:
- Successful laparoscopic pyeloplasty in 28/29 patients, with one conversion to open surgery.
- Mean operating time decreased with experience; mean blood loss was 50 cc, with no transfusions required.
- Excellent symptomatic relief reported in 26 patients, but only 6 showed improved renal function on imaging at 6 months. Five patients with preoperative function ≤25% had worsened or negligible function post-procedure.
Conclusions:
- Laparoscopic pyeloplasty is a safe and effective minimally invasive option for symptomatic relief in adult UPJO patients.
- Nephrectomy may be a viable option for UPJO patients with borderline renal function (≤25%) and a healthy contralateral kidney.
