PUJ Obstruction Treatment at Institute of Urology, Jaipur by Laproscopic Pyeloplasty: A 23-year-old male presented with complaints of intermittent left flank pain for the past few weeks. The pain was dull aching in nature and occurred episodically. There were no associated lower urinary tract symptoms such as dysuria, frequency, urgency, hematuria, or fever. There was no past history of urinary tract infections, renal calculi, or previous urological procedures. The patient had no known medical comorbidities and no prior surgical history. There was no history of drug allergy.
On clinical evaluation the patient was hemodynamically stable and systemic examination was essentially within normal limits.
Routine laboratory investigations revealed serum creatinine of 0.94 mg/dL, suggesting preserved overall renal function.
Ultrasonography of the abdomen revealed Grade I fatty liver and left pelvi-ureteric junction obstruction with gross hydronephrosis and paper-thin renal parenchyma. The right kidney appeared normal.
To further evaluate renal drainage and function, a DTPA renal scan was performed. The study demonstrated a normally functioning right kidney with no evidence of obstruction. The left kidney was enlarged and hydronephrotic with evidence of obstruction at the PUJ level. Despite the significant hydronephrosis, the left kidney maintained a significant residual renal function of 45.3% with a GFR of 45.2 ml/min, while the right kidney showed a split function of 54.7% with GFR of 54.5 ml/min. The total GFR was calculated at 99.7 ml/min, confirming adequate global renal function.
An intravenous pyelography (IVP) study showed gross hydronephrosis of the left kidney with delayed excretion of contrast, while the right kidney demonstrated normal function and drainage.
Pre-operative evaluation included chest X-ray which showed no abnormality, ECG demonstrating sinus tachycardia, and 2D echocardiography which was within normal limits with an ejection fraction of 60%. The patient was considered fit for surgery.
After appropriate counselling regarding the nature of the disease, surgical options, and expected outcomes, the patient was planned for cystoscopy with retrograde pyelography followed by laparoscopic Anderson–Hynes dismembered pyeloplasty with DJ stenting.
On 26 February 2026, the patient underwent cystoscopy and left retrograde pyelography under general anaesthesia. Cystoscopic examination revealed a normal urethra and an essentially normal urinary bladder.
Left retrograde pyelography demonstrated a normal ureter with a short segment obstruction at the pelvi-ureteric junction along with gross hydronephrosis of the renal pelvis. A ureteric catheter was placed across the PUJ.
Subsequently, laparoscopic left dismembered Anderson–Hynes pyeloplasty was performed using a three-port technique. After identification of the PUJ region, the pelvi-ureteric junction was carefully dissected and dysmembered.
Intra-operatively, multiple small calyceal stones were identified within the dilated renal pelvis and calyces. A nephroscope was introduced through an Amplatz sheath, and all visible small stones were retrieved and removed.
Following stone clearance, reconstruction was performed using the Anderson–Hynes dismembered pyeloplasty technique. The ureter was spatulated and anastomosed to the renal pelvis to ensure a dependent and tension-free drainage pathway.
A 6 Fr × 26 cm Double-J ureteric stent was placed across the anastomosis to facilitate drainage and healing. A drain tube was placed near the operative site, and the patient was catheterized. The excised segment was sent for histopathological examination.
The patient tolerated the procedure well.
The post-operative course was uneventful. The patient remained hemodynamically stable and recovered satisfactorily.
Post-operative imaging with ultrasonography and X-ray revealed status post left laparoscopic pyeloplasty with DJ stent in situ. Importantly, no significant hydronephrosis was seen in the left kidney, suggesting adequate decompression. A minimal amount of left pararenal fluid was noted without any significant collection. A minimal left pleural effusion was also observed, which was clinically insignificant.
The drain tube was removed on 01 March 2026 after ensuring minimal output.
The patient showed good clinical recovery and was discharged in stable condition with advice for follow-up and subsequent DJ stent removal.
This case highlights a classical presentation of pelvi-ureteric junction obstruction in a young adult with associated calyceal calculi, successfully managed by laparoscopic Anderson–Hynes pyeloplasty with simultaneous stone clearance. The preservation of significant renal function on pre-operative DTPA scan supported reconstructive surgery, and the minimally invasive approach allowed effective relief of obstruction with excellent post-operative recovery.
