What are the steps of an open Anderson pyeloplasty?

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Last updated: November 4, 2026 • View editorial policy

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Open Anderson-Hynes Pyeloplasty: Surgical Steps

The open Anderson-Hynes pyeloplasty involves dismembering the ureteropelvic junction, spatulating both the ureter and renal pelvis, then performing a tension-free anastomosis to create a wide, funnel-shaped drainage pathway.

Surgical Technique

Patient Positioning and Exposure

  • Position the patient in lateral decubitus position with the affected side up
  • Make a flank incision (typically subcostal or dorsal lumbotomy approach)
  • Mobilize the colon medially to expose the retroperitoneum
  • Open Gerota's fascia to access the renal pelvis and proximal ureter

Identification and Mobilization

  • Identify and dissect the dilated renal pelvis off surrounding structures
  • Locate the ureteropelvic junction (UPJ) and proximal ureter
  • Mobilize the ureter distally until normal caliber ureter is reached beyond the obstruction
  • If a crossing vessel is present, preserve it and plan to transpose the anastomosis anteriorly 1
  • Place traction sutures on the renal pelvis to facilitate handling

Dismemberment and Preparation

  • Excise the stenotic UPJ segment completely
  • Trim excess redundant renal pelvis to create appropriate pelvic size (reduction pyeloplasty if needed)
  • Spatulate the ureter laterally for 1-2 cm to create a wide opening
  • Create a corresponding spatulation on the dependent portion of the renal pelvis

Anastomosis (Anderson-Hynes Technique)

  • Position the spatulated ureter to the most dependent part of the renal pelvis
  • If a crossing vessel exists, bring the ureter anterior to the vessel to prevent recurrent obstruction 1
  • Perform the anastomosis using fine absorbable sutures (typically 4-0 or 5-0) in interrupted or running fashion
  • Begin at the apex of the spatulation and work circumferentially
  • Ensure a tension-free, watertight anastomosis creating a wide funnel-shaped connection
  • The anastomosis should be approximately 2-3 cm in length when completed

Stenting and Drainage

  • Place a double-J ureteral stent antegrade from the renal pelvis into the bladder before completing the anastomosis 1, 2
  • Confirm proper stent positioning (can use methylene blue reflux from bladder to verify) 1
  • Place a surgical drain near the anastomosis
  • Close Gerota's fascia loosely around the repair
  • Close the wound in layers

Key Technical Points

Critical pitfalls to avoid:

  • Inadequate excision of the stenotic segment leads to recurrent obstruction
  • Tension on the anastomosis increases stricture risk—ensure adequate ureteral mobilization
  • Failure to position the anastomosis anterior to crossing vessels causes persistent obstruction
  • Excessive reduction of the renal pelvis can compromise blood supply

In duplicated systems, drainage of both moieties requires custom planning and can be technically challenging 1. The stenosis length typically measures 1.0-1.5 cm 2, and complete excision of this segment is essential for success.

The overall success rate for properly performed pyeloplasty exceeds 90% 2, with success defined as relief or stabilization of hydronephrosis and resolution of symptoms. Stent removal typically occurs at 4-6 weeks postoperatively 1, with drain removal within the first postoperative week.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.