Kidney · Reconstructive urology
Pyeloplasty for impaired urine drainage
When urine backs up in the kidney, it suffers silently. The narrowing can be corrected.
Problem
Impaired drainage
at the junction of renal pelvis and ureter
Goal
Free drainage
the narrowed segment is reconstructed
Access
Robot-assisted
reconstruction through a few small ports
The condition
Urine leaves the kidney through the renal pelvis and flows down the ureter into the bladder. If the junction between the two is narrowed — a so-called ureteropelvic junction (UPJ) obstruction — urine backs up into the kidney.
The narrowing can be congenital and cause symptoms only in adulthood. It can also develop later: through scar tissue, after inflammation, after previous procedures or through stones. Often a blood vessel crosses the ureter and compresses it — a so-called crossing vessel.
If the back-up persists, kidney function on that side slowly declines — often without any pain. That is the reason to treat impaired drainage even when symptoms are mild.
How you may notice it
Recurring pain in the flank, often after drinking larger amounts
Repeated urinary tract infections or fever
Kidney stones
Blood in the urine
Nausea and vomiting during attacks of pain
A build-up of urine in the kidney that shows on imaging — sometimes without any symptoms at all
Second opinion
A congested kidney or recurring flank pain? Have the drainage assessed.
How it proceeds
Before the operation
The diagnosis rests on ultrasound and cross-sectional imaging; a split renal function study shows how much the affected kidney still contributes and how severely drainage is obstructed.
The operation
The narrowed segment is removed and the junction between renal pelvis and ureter is sutured anew, wide and free of tension. If a crossing vessel presses on the ureter and causes the narrowing, the connection is repositioned so that the vessel no longer compresses it. A thin ureteric stent is placed temporarily to support healing.
After the operation
The stent stays in place for some time and is then removed in a short procedure. Whether drainage remains free in the long term is checked afterwards with ultrasound and a renal function study.
Why robot-assisted
Pyeloplasty is reconstruction, not removal. Its result depends on a fine, watertight, tension-free suture line in a spot that is hard to reach.
This is exactly where the robot-assisted technique plays to its strength: articulating instruments that follow the hand across several axes of movement, a three-dimensional magnified view and the filtering out of natural hand tremor. Compared with the open approach through a flank incision, the ports stay small.
Reconstruction means suturing: tight angles, fine thread — that is what the articulating instrument tip is made for.
How the repair works
The narrowed segment is removed and the junction rebuilt wide.
The narrowing dams up the urine. Dashed: what is removed.
Pelvis and ureter are sewn back together wide — over an internal stent.
Urine drains freely again. The stent is removed once healing is complete.
Schematic illustrations — not images of a patient.
Contact
Having impaired kidney drainage assessed
Bring your ultrasound and cross-sectional images and any existing renal function study. We will put the findings in context together.
Consultation hours
- Wednesday · 14:00
- Thursday · 08:30–16:00
PD Dr. med. Sami-Ramzi Leyh-Bannurah. Appointments are arranged by the urology secretariat.