Laparoscopic Pyeloplasty for Pelvi-ureteric Junction Obstruction (PUJO)

PUJ obstruction is a congenital (developmental) abnormality of transport at the junction of the renal pelvis and the ureter, resulting in obstruction. This typically presents in:

• infants on ultrasound screening
• young adults with flank pain, often associated with alcohol and caffeine
• older adults with kidney infection and non-functioning kidney

Surgery aims to relieve the obstruction, curing symptoms and preventing functional deterioration. It is not generally possible to recover that function already lost. There is a range of procedures available, but the most effective and reliable involves removing the abnormal segment and rejoining the kidney to the ureter. This may be achieved through open surgery or laparoscopically.

Laparoscopy is associated with less pain, fewer problems and superior recovery when compared to the open procedure, allowing earlier return to normal function and fewer long-term complications. The scars are small and cosmetically better. However, the technique is more difficult and more expensive, with longer operating times.

The procedure is performed under general anaesthetic. Recovery is generally quick, with a hospital stay of 1-2 days. An internal plastic stent is left in the ureter, from the kidney to the bladder, which must be removed 2-3 weeks after the surgery, by flexible cystoscopy.

Although most cases proceed without particular difficulty and have excellent outcomes, surgical complications occur overall in 5% of patients. Those recognised as common or serious are listed below but this does not include the rare and extraordinary. From data on fit kidney donors, risk of death is 0.03%. We try at all costs to avoid any adverse outcome.

This fact sheet complements the discussion during your consultation, which will apply your individual circumstances to the above facts.