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The introduction of hand-assisted laparoscopic surgery (HALS) adds another dimension to standard laparoscopy, and particularly benefits the urologic laparoscopist who performs laparoscopic renal procedures. Hand assistance shortens the initial learning curve for laparoscopic nephrectomy and creates alternatives for more experienced laparoscopists. HALS can be performed on any kidney suitable for intact removal, and is well suited to laparoscopic donor nephrectomy, radical nephroureterectomy, and radical nephrectomy with intact removal. The authors' technique, early experience, and indications for hand assistance are described in detail.

The modern day treatment of UPJO with retrograde endopyelotomy continues to evolve as experience and knowledge progress. Use of the straight lateral incision and selective use of spiral CT angiogram has refined treatment decisions with retrograde endopyelotomy further. The authors' decision-oriented approach offers guidelines for the practicing urologist. Ultimately, it is up to the urologist and the patient to select the best approach for each clinical scenario.