Pyeloplasty

What is pyeloplasty and when is it needed?

Pyeloplasty is a reconstructive operation on the kidney's drainage system. Urine collects in the renal pelvis, the funnel at the centre of the kidney, and leaves through the ureter. If the point where they join, the pelviureteric junction (PUJ), is narrowed, kinked or crossed by a blood vessel, urine cannot drain freely. The pelvis swells (hydronephrosis), and over time this can cause flank pain, repeated urine infections, kidney stones and a slow loss of kidney function. In pyeloplasty the surgeon removes or opens the narrowed segment and rejoins the pelvis and ureter so that urine flows downhill again. The operation is done in adults and in children, and hospitals in Turkey offer it by open, laparoscopic and robot-assisted routes.

This guide explains how the blockage is confirmed, how the techniques differ, what the evidence says, what the operation costs compared with the UK, US and Germany and what recovery with a ureteric stent involves. For other kidney and bladder procedures see our urology treatments in Turkey.

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How is a PUJ blockage diagnosed before pyeloplasty?

Not every widened kidney needs surgery, so the first step is to prove that the blockage matters. Typical tests are an ultrasound scan, a CT urogram or MR urogram to show the anatomy, and a nuclear renogram (MAG3 scan), which measures how much each kidney contributes to kidney function and how quickly it drains. Surgery is usually advised when there is pain or infections that keep returning, stones forming above the narrowing, declining function in the affected kidney or a clearly obstructed drainage pattern on the renogram. If the scans show a mild, stable widening without symptoms, many urologists prefer to observe with repeat scans. Bring any previous scans and reports; they allow a Turkish surgeon to give an informed opinion before you travel.

Does pyeloplasty work? What the evidence says

Pyeloplasty is the long-established standard treatment for PUJ obstruction. Published series from specialist centres report relief of symptoms and improved drainage in the large majority of patients, commonly around nine in ten or higher, with results that are similar for open, laparoscopic and robotic approaches. What it does not do is restore kidney tissue that has already been lost: if function was low before surgery, the aim is to protect what remains. Narrowing can return in a minority of patients, usually within the first year or two, which is why follow-up scans matter. A reliable surgeon will explain these limits and will not promise that the kidney returns to normal.

Pyeloplasty cost in Turkey compared with the UK, US and Germany

The ranges below are approximate figures for the whole operation, not hospital quotes. Price varies with the technique (robotic surgery usually costs more than open), the length of the stay, whether the patient is a child, and whether a stone is removed in the same operation. Each hospital confirms its price in a written plan.

A package normally includes the pre-operative tests, the surgeon and anaesthetist, the operating theatre, the ureteric stent, hospital nights, medication and airport transfers. Ask whether the cystoscopy to remove the stent, and any extra scans, are included or would be arranged at home.

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Open, laparoscopic or robotic pyeloplasty: which technique?

The principle is the same in every method: the narrowed segment is removed or widened and the ureter is stitched to the pelvis over a stent (the Anderson-Hynes dismembered repair is the most common). What differs is the access.

Keyhole and robotic routes mean smaller scars and a shorter stay for most adults, which suits a trip abroad; open surgery remains valuable for babies and for difficult anatomy. A surgeon should explain why a given approach fits your case rather than quoting the most expensive option.

What happens on the day: the operation step by step

• Anaesthesia: general anaesthesia is used for all methods.
• Stent placement: some surgeons place a thin ureteric stent through the bladder first; others insert it during the repair.
• Access: an incision in the flank for open surgery, or three to four small incisions for laparoscopic or robotic surgery.
• Repair: the narrowed segment is cut out, the ureter is shaped and sewn to the pelvis with dissolving stitches, and a blood vessel that crosses the junction is moved out of the way if it is the cause.
• Drain and closure: a small drain may be left for a day or two, and the wounds are closed.

The operation takes about two to four hours. If a kidney stone is present, the surgeon can remove it during the repair; stones on their own are usually treated with a different, endoscopic procedure.

What is the ureteric stent and when does it come out?

The stent is a thin plastic tube running from the kidney to the bladder that keeps the new join open while it heals. It stays for about four to six weeks. Many people notice a need to pass urine more often, mild flank discomfort when passing urine and a little blood in the urine; these are common and settle after the stent is removed. Removal is a short cystoscopy under local or light general anaesthesia. Because the stent usually stays in longer than a typical hospital visit, discuss in advance whether removal will be done by a urologist in your home country, with the operation report and the stent type in hand, or whether you will return to Turkey for it.

Who is a good candidate for pyeloplasty, and who is not?

Suitable patients have a confirmed obstruction at the PUJ with symptoms, infections, stones or falling kidney function, and are fit for general anaesthesia. It is not suitable when the widening is mild and stable, when the problem is a blockage lower in the ureter (a different operation), or when infection is untreated; surgery is delayed until the urine is clear. In severely damaged kidneys with almost no function, removal of the kidney (nephrectomy) may be discussed instead. Tell the team about previous kidney or abdominal surgery, solitary kidney, diabetes, anticoagulant tablets and any allergies.

How long is the stay in Turkey and what is recovery like?

After keyhole or robotic surgery most adults stay in hospital for two to three nights, and after open surgery about four to five. The bladder catheter and drain usually come out within one to three days. Most patients stay in Turkey for five to seven nights in total so the surgeon can check the wound and urine before the flight. Light activity starts at once; desk work often resumes after two to three weeks, and heavy lifting and contact sport wait for about four to six weeks. Short flights are generally allowed once the surgeon agrees; drink plenty of water and keep walking. A renogram or ultrasound a few months later confirms that drainage has improved.

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What are the risks of pyeloplasty?

Pyeloplasty is well established but not free of risk. Possible problems include urine infection, a urine leak at the join, bleeding, stent discomfort or stent blockage, a blood clot in the leg, and in rare cases injury to nearby organs. In a minority of cases the narrowing returns and a second procedure is needed. Fever, worsening flank pain, heavy bleeding or inability to pass urine after you get home should be treated as urgent, in line with advice from the NHS and the European Association of Urology. Ask the clinic how it manages leaks and infections and who will care for you if a problem appears after the flight.

How to choose a urology surgeon and hospital, and red flags

Look for a urologist who performs reconstructive kidney surgery regularly, a hospital with an intensive-care unit and the equipment for the technique you are offered, and a team that reviews your scans and renogram before quoting. Urology departments in Turkey often cover a wide range, from kidney operations to men's health procedures such as circumcision or penis enlargement; breadth alone does not show experience in pyeloplasty, so ask directly how many you do each year. Red flags include a firm quote with no imaging review, promises that the kidney will return to normal, no plan for stent removal, and pressure to pay a deposit quickly. Our page on how it works sets out the process, and you can request a plan through our free quote form.

Questions to ask the clinic

• Which technique do you recommend for me and why?
• How many pyeloplasties, adult and paediatric, do you perform a year?
• Who will remove the stent, when, and is it included in the price?
• How many nights in hospital and how many days in Turkey?
• What follow-up scans are advised, and will you share the report?

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Hospitals with Urology in Turkey

Academic Hospital

Üsküdar, Istanbul

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Lokman Hekim Istanbul Hospital

Pendik, Istanbul

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