What are the indications for a robotic pyeloplasty?
A pyeloplasty may be recommended when a narrowing at the pelviureteric junction (PUJ) blocks free drainage of urine from the kidney. Typical indications for surgery include:
- Loin pain caused by the obstruction, especially after drinking fluids.
- Reduced kidney function on the affected side.
- Recurrent kidney infections or stones linked to poor drainage.
- A blockage confirmed on a radionucleotide diuretic renogram (drainage scan).
What are the alternatives?
- Observation — If symptoms are minor and function is preserved.
- Endopyelotomy — Cutting the narrowing telescopically with a fine wire or laser.
- Balloon dilatation — Stretching the narrowing under X-ray guidance.
- Temporary stenting — Plastic tube placement to hold open the narrowed area.
- Open pyeloplasty — Reconstruction through an incision in the loin.
What happens before surgery?
You will be asked to attend for a pre-operative assessment approximately 2-3 weeks before surgery, where blood tests and an ECG are typically performed to ensure the procedure takes place with minimal risk. Most patients should continue regular medication, although certain medications should be stopped prior to surgery. Please tell the team if you take blood thinners or have any implants, a pacemaker or a history of MRSA.
On the day of surgery you should avoid eating for six hours before the procedure, and drink only clear fluids within 2 hours of the procedure. You will be given a gown and compression stockings to wear, your consent will be confirmed, and an anaesthetist will discuss your anaesthetic and pain relief.
What does the procedure involve?
- Performed under general anaesthetic, with antibiotic cover.
- Five or six small incisions in the abdomen.
- The ureter is identified and followed to the narrowed area at the PUJ.
- The narrowed segment is then removed and the ureter rejoined to the pelvis of the kidney.
- An internal stent is placed in the ureter to support healing, along with a small abdominal drain and sometimes a urinary catheter.
- Typically the abdominal drain and catheter are removed within 24 hours. Most patients are discharged on the first post-operative day.
What are the side-effects?
- Shoulder-tip pain and abdominal bloating from the gas (almost all patients).
- Loin pain and bladder irritation due to the stent (almost all patients).
- Bleeding, infection, pain or hernia at a port site (5-10%).
- Urine leak requiring prolonged drainage or return to theatre (1-5%).
- Recurrent narrowing needing further surgery (5-10%).
- Conversion to open surgery, injury to nearby structures, or later loss of the kidney (less than 1%).
What happens after surgery?
You will be encouraged to get up and about quickly. The drain and catheter are usually removed within 24 hours of surgery, after which you will be allowed home. The internal stent stays in for four to six weeks and is then removed under local anaesthetic using a flexible cystoscope. Most people return to normal activities within two to four weeks.
A MAG-3 diuretic renogram (kidney drainage scan) is usually performed around 12 weeks after surgery to confirm that kidney drainage has improved. The results will then be reviewed with you at a follow-up clinic appointment.
Patient information leaflet
Read the British Association of Urological Surgeons (BAUS) leaflet: Keyhole reconstruction of the kidney pelvis (pyeloplasty).
View the BAUS leaflet
Patient information video
Watch the NHS Frimley Health animated video:
Robotic-assisted Laparoscopic Pyeloplasty