Techniques
All four approaches aim to widen the ureteropelvic junction so the kidney drains freely. They differ in invasiveness, hospital stay, and long-term success. Dr Kooner offers each approach and selects the best fit at consultation.
Keyhole dismembered reconstruction using the da Vinci platform, with 3D vision and articulated instruments. The preferred first-line repair for most adults.
Open robotic pageTraditional keyhole reconstruction using straight instruments. Technically demanding but avoids the open incision.
Open laparoscopic pageHistorical flank-incision reconstruction. Still used when keyhole access is not suitable - for example, after complex prior surgery.
Open open pageRetrograde holmium laser incision through the urethra. Lower success than reconstruction but avoids any incision and suits selected patients.
Open endopyelotomy page| Approach | Typical hospital stay | Published success | Incision |
|---|---|---|---|
| Robotic | ~2 days | >95% | 4 small ports |
| Laparoscopic | 2 to 3 days | ~90% | 3 to 4 small ports |
| Open | 7 to 10 days | ~90 to 95% | Flank incision |
| Laser endopyelotomy | Overnight or day-case | ~75% | None (via urethra) |
Success figures are drawn from peer-reviewed series cited on the outcomes page. Individual results depend on anatomy, whether a crossing vessel is present, and patient factors.
Dr Kooner's default offer for an adult with a clearly obstructing UPJ and reasonable kidney function is robotic pyeloplasty. Laparoscopic reconstruction is reserved for selected anatomies in centres without robotic access. Open pyeloplasty is offered when previous surgery or anatomical considerations mean keyhole access would not be safe. Laser endopyelotomy is offered to patients with a shorter narrowing who prefer a retrograde approach, or who have had previous reconstruction that has narrowed again.
Factors weighed at the consultation include:
The rooms can arrange a consultation to review imaging, confirm obstruction with a drainage study, and outline which pyeloplasty approach fits your situation.