When open pyeloplasty is still used
- Extensive previous abdominal or retroperitoneal surgery where keyhole dissection would not be safe.
- Very unusual anatomies, including some revision cases after a failed previous reconstruction.
- Patients whose general health, body habitus, or prior surgery means a pneumoperitoneum is not tolerated.
- Centres without access to a robotic system, when the surgical team's laparoscopic pyeloplasty experience is limited.
How it is done
- General anaesthetic.
- A 15 to 20 cm incision is made along the loin, just under the 12th rib. Muscle layers are separated to reach the kidney.
- The renal pelvis and upper ureter are exposed. Any crossing vessel is moved out of the way.
- The narrow segment is excised, the ureter is spatulated, and the ureter is sewn to a healthy portion of the renal pelvis over a double-J stent.
- The muscle layers and skin are closed in layers. A drain is commonly left for a few days.
Hospital stay and recovery
- Typical hospital stay: 7 to 10 days.
- Back to normal activities: 2 to 3 months.
- Stronger post-operative pain than with keyhole repairs because of the muscle-splitting flank incision.
- Ureteric stent removal at 4 to 6 weeks.
- MAG3 renogram at 3 to 6 months.
Risks and considerations
- General anaesthetic risks.
- Wound-related complications (infection, hernia at the incision, prolonged pain at the scar).
- Urine leak from the new join while the stent is in place.
- Bleeding, particularly in revision cases.
- Long-term recurrence of narrowing, uncommon but possible.
Outcomes compared with robotic
A 2023 systematic review (Moretto and colleagues) compared robotic and open pyeloplasty and reported similar long-term success rates, with the robotic approach delivering faster recovery and shorter hospital stay. Where both approaches are available, the balance clearly favours robotic repair; open pyeloplasty remains useful as a considered choice when it is the safer option.
Alternatives