An incision is made in the lower back of the patient near the kidneys, and through this opening, the surgeon removes the obstruction and refashions the narrow passage way and attaches the kidney and ureter as a result of which the urine can flow more easily. The incision is then closed with stitches. This procedure is called open pyeloplasty. In laparoscopic pyeloplasty, the surgeon uses keyhole surgery to perform the same procedure. Here the surgeon makes several small incisions and a telescope with small video camera mounted on it is passed through these incisions to examine the abdomen. CO2 gas is filled to inflate the abdominal region and surgeon operates with specialized instruments to remove the obstruction and repair the damage.

After the surgery, a stent which is fine thin plastic tube is also inserted to keep the new connection open during the healing process. The surgeon uses a fine telescope which is passed into the bladder to monitor the stent which is removed one week after the surgery has been completed.

There is chance for bleeding during and after the operation. Also there is possibility of urine leakage at the new joint and narrowing of the passage again leading to a second surgery. Infections can be prevented by using the prescribed antibiotics. However this technique has the highest success rate as compared to others.