A 22-year-old woman has recurrent dull right flank ache. Ultrasound shows gross pelvicalyceal dilatation with calyceal clubbing but a completely normal calibre ureter. A MAG3 diuretic renogram shows poor tracer washout from the right kidney after furosemide. Which procedure offers definitive treatment?
- A Percutaneous nephrolithotomy
- B Ureteroscopic endopyelotomy
- C Dismembered (Anderson-Hynes) pyeloplasty ✓
- D Transureteroureterostomy
Correct answer: C. Dismembered (Anderson-Hynes) pyeloplasty
Explanation
Pelvicalyceal dilatation with a normal ureter and absent washout after furosemide on diuretic renography confirms pelviureteric junction obstruction. The standard definitive operation is the Anderson-Hynes dismembered pyeloplasty, excising the dysfunctional segment and creating a dependent anastomosis, with success rates around 90 percent. Endopyelotomy is reserved for selected secondary strictures and has lower success. Normal ureteric calibre excludes distal pathology needing ureteric reconstruction.
Reference: Bailey and Love Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.