Abstract Introduction A variety of causative factors in combination or isolation can result in obstruction either intrinsic or extrinsic namely crossing vessels, high insertion of ureter, and isthmus in a horseshoe kidney (HSK). This video highlights the key points in the context of such anatomical variations. To perform a laparoscopic dismembered pyeloplasty for a pelvi-ureteric junction obstruction (PUJO) in an HSK it is crucial to understand detailed anatomy. A key factor is the awareness and recognition of several aberrant vessels in the region of the isthmus, ureter, and pelvis. Careful dissection of crossing vessels is necessary to avoid injury, as well as manipulate and transpose them behind the ureter with a ureteropelvic anastomosis anterior to these vessels. Generous ureteric spatulation and a well-mobilized pelvis draws the neo-PUJ over the isthmus to a dependant position. The preference of a JJ stent over a nephro-stent is strongly recommended. Isthmectomy is unnecessary as the same outcomes can be achieved with less morbidity.Conclusions Laparoscopic dismembered pyeloplasty for a PUJO in a horseshoe kidney is a very effective and safe procedure. However, awareness of several structural anomalies in this group makes this surgery different and more demanding when compared to a standard pyeloplasty.
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