Once the diagnosis of ureteropelvic junction (UPJ) obstruction has been made, management of this depends on the severity of the case. Indications for dismembered pyeloplasty or any other operative therapy are variable. Most physicians consider the presence of symptoms from the obstruction, such as recurrent flank pain, nausea, and vomiting, to be indications for interventions. Other indications include recurrent urinary tract infections, pyelonephritis, ipsilateral nephrolithiasis, and deterioration in renal function.
 

1. To prevent possible complications, your doctor will provide preoperative instructions that will likely include stopping smoking and drinking alcohol as well as assess any existing health conditions, such as diabetes and obesity.
2. You will undergo blood and urine tests.
3. You will be given a laxative to empty your bowels.
4. You will need to avoid food and water for six to eight hours before the procedure or as recommended by your doctor.
5. Please let your doctor know if you are taking any medication as some may need to be stopped before the procedure.
6. The procedure is performed under general anesthesia so you will be asleep for it.

1. A urinary catheter will be placed before the surgery.
2. Pyeloplasty may be done laparoscopically or through traditional open surgery.

• In some cases a temporary stent may be placed to allow urine to flow while the ureter heals.
• The procedure takes two to three hours and requires a hospital stay of two to three nights. The stay may be longer if complications arise.

3. In an open surgery, an incision will be made in the skin over the kidney. The obstructed portion will then be removed and the ureter will be attached to the kidney pelvis.
4. In a laparoscopic method, several small incisions will be made to insert a camera and small surgical tools to remove the obstruction.

1. You are likely to feel some discomfort when urinating after the procedure. You may feel the urge to urinate frequently.
2. Avoid contact with the incisions to prevent infection.
3. You may return home with a catheter in place. It is usually removed after one week. (Please do not remove it yourself.)

All types of surgery have risks and your doctor will take all the steps required to prevent complications. Nonetheless, possible risks and complications of surgery include:

• Excessive bleeding.
• Infection.
• Hernia in the area operated on.
• Injury to nearby tissue or organs.
• Urine leakage.
• Ureter blockage.

• If you are taking any blood-thinning medication/anticoagulant, please let your doctor know as some may need to be stopped before you travel for the procedure.
• Travelers to Thailand should plan to stay in the country for at least one to two weeks or for the entire duration of treatment.
• If you plan to return home after the procedure, please speak to your doctor before making travel arrangements. There are no restrictions for air travel.
• During your follow-up appointment your medical team will assess your health and your incision and you will receive documents detailing your medical and treatment history and your "Fit to Fly" certificate (if needed).

The success of the procedure depends on a number of factors. Please discuss the likelihood of success with your doctor before the procedure.
 
What if the procedure is not performed?
If not treated, it can lead to damage in the kidney. Please discuss specific risks of not having the procedure done with your doctor.
 

Laparoscopic surgery of the bladder and ureters or laser treatments to attach a balloon and place a ureteric stent at the narrowed area, which is usually done six weeks after the surgery.