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

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.