Anderson–Hynes pyeloplasty: are we all really on the same page?

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Background:The Anderson–Hynes pyeloplasty (AHP) is a surgical technique used in the management of pelvi-ureteric junction obstruction. This operation has been performed for over six decades and has etched its name in the annals of urology. But are we all really referring to the same procedure?Methods:A systematic review of the Ovid MEDLINE(R) and Ovid OLDMEDLINE(R) database from 1946 to 20 June 2014 was performed for the terms ‘Anderson and Hynes’ and ‘Anderson–Hynes’, with later restriction to the title of journal article. Each respective author's descriptive images (figures/photographic) of technique performed was compared with the original procedure. Non-English figure legends were translated using online translational tools.Results:In total, 242 articles were retrieved. Streamlining this search to articles with the above search terms restricted to article title revealed 58 (34 English/24 non-English) articles. Only 29/58 papers had referenced the original procedure. Operative images were present in 17/58 of the articles claiming to have performed the AHP. Within these papers, only 7/17 articles depicted both the L-shaped cut and pelvic flap. Diverse variations were observed in the remainder 10/17 articles. This was a worldwide phenomenon, observed more commonly in recent decades and when minimally invasive techniques were used.Conclusion:The AHP is often not performed as was originally described. Over the decades, surgeons have unknowingly attributed variations to this procedure. Based on this review, a novel ‘geometric classification’ system has been proposed to better define the dismembered pyeloplasty.

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