Ureteropelvic junction obstruction. Open operative intervention

The indications to intervene for ureteropelvic junction (UPJ) obstruction have not changed despite the introduction of newer, less invasive techniques for definitive management. In contemporary practice, open operative intervention is still appropriate for those patients in whom alternative management has failed or is contraindicated, or for those in whom an unobstructed UPJ needs to be assured with the highest certainty--both immediately and with long-term follow-up. Although several techniques have been described for open operative reconstruction of an obstructed UPJ, a dismembered pyeloplasty has proven to be the most versatile, and should be a part of every urologist's treatment armamentarium. Alternative primary and salvage techniques for open operative reconstruction of the UPJ are also described in this article.