Work

Pelvic sleeve pyeloplasty in adults: A technical refinement of Anderson–Hynes dismembered pyeloplasty

Year: 2026

Type: article

Abstract: Objectives: To describe pelvic sleeve pyeloplasty, a technical refinement of Anderson-Hynes dismembered pyeloplasty for adult ureteropelvic junction obstruction, and to report perioperative and functional outcomes in an initial adult series. Methods: Between 2009 and 2018, 12 adult patients with symptomatic ureteropelvic junction obstruction underwent pelvic sleeve pyeloplasty using a transperitoneal laparoscopic or robot-assisted approach. Preoperative evaluation included computed tomography intravenous pyelography and diuretic Tc-99m MAG3 renography. Patients with previous failed ureteropelvic junction surgery were excluded. The technique preserves and incorporates a sleeve of renal pelvic tissue into the reconstruction to create a broad, continuous, tension-free ureteropelvic anastomosis while minimizing manipulation of healthy ureteric tissue. Results: All procedures were completed successfully without conversion to open surgery. Eight patients underwent laparoscopic and four underwent robot-assisted pyeloplasty. Mean operative time was 185 min (range 160-255 min), and estimated blood loss ranged from 90 to 350 mL. One patient had intraoperative bleeding from a gonadal vein injury, controlled without transfusion. One patient developed a transient postoperative febrile episode (Clavien-Dindo grade II). No patient developed urinary leakage or required secondary intervention. At a mean follow-up of 38 months (range 24-50 months), all patients were asymptomatic and diuretic Tc-99m MAG3 renography demonstrated unobstructed drainage. Conclusions: Pelvic sleeve pyeloplasty is a feasible modification of dismembered pyeloplasty that preserves ureteric length, minimizes ureteric manipulation and facilitates a wide, continuous, tension-free ureteropelvic anastomosis. Larger comparative studies are required to validate reproducibility and long-term efficacy.

Source: BJUI Compass

DOI: 10.1002/bco2.70301

Author: Dinesh K. Agarwal

Institutions: The Royal Melbourne Hospital, The University of Melbourne, Western Health

Language: English

Topic: Pediatric Urology and Nephrology Studies

Subfield: Pediatrics, Perinatology and Child Health

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,770