Pyeloplasty

Abstract

Widespread use of maternal ultrasound has significantly changed the practice of paediatric urology. Pelvi-ureteric junction (PUJ) obstruction is the most common cause of hydronephrosis detected antenatally. Controversy continues on the optimal timing of surgical intervention in children with antenatally detected hydronephrosis. The decision to intervene surgically in these infants has become more complex because spontaneous resolution of antenatal and neonatal upper urinary tract dilatations is being increasingly recognized. The gold standard surgical procedure for PUJ obstruction is the Anderson-Hynes dismembered pyeloplasty, traditionally performed with an open flank approach. Recent technological advances and a shift across all surgical fields to embrace minimally invasive surgery have led to increased utilization of minimally invasive pyeloplasty. Laparoscopic pyeloplasty has the technical challenges of precise suturing in a confined space and also considerable learning curve. Robotic technology in recent years, has simplified the minimally invasive approach, offering enhanced visualization and improved dexterity with a fairly short learning curve.