Reconstructive Urology

Long segment PUJO

5 stages · 27 October 2026

Unlike standard PUJ obstructions, which typically involve a very short, localized segment, a "long segment" stricture spans down the upper ureter. This makes standard surgical fixes more challenging. In such cases, one may not be able to perform a dismembered pyeloplasty; hence, there should always be a backup before you proceed with transection. This can be in the form of a spiral flap (Culp-DeWeerd), a vertical flap (Scardino-Prince), Buccal Mucosa Graft (BMG) ureteroplasty, or ureterocalicostomy. This patient was taken for laparoscopic pyeloplasty. A preoperative retrograde pyelogram was performed because the CT findings were equivocal and showed a long-segment PUJ stricture. The case was converted to open, and luckily, we were able to do A-H dismembered pyeloplasty after good renal mobilisation. In most cases, we do not do RGP's but If non-invasive imaging does not clearly map the stricture, RGP provides real-time visualization of the pelvic-ureteric geometry.

Published with the patient's consent, for general information only. Every patient and operation is different.

Long segment upper ureter structure

Pelvis

Upper ureteric structure in scan

Ureter dismembering done

Structure segment laid open till normal ureter