Minimally Invasive Techniques for Ureteropelvic Junction Obstruction

Ureteropelvic junction obstruction (UPJO) is a leading cause of hydronephrosis and can progressively impair renal function if left untreated. Over recent decades, minimally invasive interventions have supplanted open repair in many centres, offering equivalent success rates with reduced postoperative pain and shorter hospital stays. Endourological options such as endopyelotomy and balloon dilatation provide percutaneous or ureteroscopic relief of obstruction, while laparoscopic pyeloplasty—most commonly employing a dismembered Anderson-Hynes technique—can be performed via transperitoneal or retroperitoneal access. The introduction of robotic assistance has further enhanced suturing precision, three-dimensional visualisation and ergonomic comfort, broadening applicability in both paediatric and adult populations. Advances in microlaparoscopy have enabled safe repair even in infants under one year, and emerging approaches like single-site laparoscopy and natural orifice transluminal endoscopic surgery (NOTES) are under evaluation. Although minimally invasive procedures often entail longer operating times and demand specialised training, their favourable complication profiles and rapid recovery have driven widespread adoption. Current efforts are directed towards refining instrument design, defining optimal patient selection criteria and integrating new robotic platforms to ensure global accessibility and sustainable, cost-effective care.

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Minimally Invasive Techniques for Ureteropelvic Junction Obstruction publication trend

The graph below shows the total number of articles in minimally invasive techniques for ureteropelvic junction obstruction across all publications each year (not limited to Nature Index journals).

Technical terms

Hydronephrosis: Dilation of the renal pelvis and calyces resulting from urinary tract obstruction.

Pyeloplasty: Surgical reconstruction of the ureteropelvic junction to relieve obstruction and restore urine flow.

Endopyelotomy: Endoscopic incision of the narrowed ureteropelvic junction to alleviate stenosis without open surgery.

Laparoscopy: Minimally invasive surgery using small incisions, a camera and specialised instruments to access the abdominal cavity.

Robotic-Assisted Laparoscopic Pyeloplasty: Laparoscopic pyeloplasty enhanced by robotic systems that improve dexterity, stability and three-dimensional visualisation.

Retroperitoneal Approach: Surgical access to the ureteropelvic junction through the retroperitoneal space, avoiding entry into the peritoneal cavity.

References

1. Surgical approaches for treatment of ureteropelvic junction obstruction – a systematic review and network meta-analysis. BMC Urology (2019).
2. Is Laparoscopic Pyeloplasty for Ureteropelvic Junction Obstruction in Infants Under 1 Year of Age a Good Option?. Frontiers in Pediatrics (2019).
3. Retroperitoneal Approach for Ureteropelvic Junction Obstruction: Encouraging Preliminary Results With Robot-Assisted Laparoscopic Repair. Frontiers in Pediatrics (2019).