Background: Pelvic and crossed renal ectopia are rare anomalies that can be complicated by pelvi-ureteric junction obstruction (PUJO). Surgical reconstruction is challenging because of aberrant anatomy. Anderson–Hynes dismembered pyeloplasty remains the gold standard for PUJO repair. We report outcomes of open pyeloplasty in ectopic kidneys from a single tertiary center. Methods: Five consecutive adult patients with ectopic kidneys and PUJO underwent open Anderson–Hynes dismembered pyeloplasty at Calcutta National Medical College between December 2023 and August 2025. Diagnosis was confirmed by ultrasonography (USG), contrast-enhanced CT urography, and Tc-99m DTPA diuretic renography. Patients were followed with clinical evaluation, serum creatinine, urinalysis, renography at 6 and 12 months, and ultrasound semiannually. Primary outcome was functional improvement on DTPA; secondary outcomes were hydronephrosis regression and need for re-intervention. Results: Median age was 28 years (range 18–42). Three patients had left pelvic kidneys, one right pelvic, and one left crossed ectopic kidney. Four presented with abdominal pain, one was incidental. Aberrant vessels were present in 3/5 cases. Four patients (80%) demonstrated functional improvement on DTPA; hydronephrosis improved in only two (40%). One patient (20%) with a left pelvic kidney developed recurrent pain and UTI, representing functional failure, and required postoperative double-J stenting. No major complications were recorded. Conclusions: Open dismembered pyeloplasty is effective in ectopic kidneys with PUJO, providing functional improvement in most cases. Radiologic hydronephrosis resolution is less consistent, and some patients may require secondary intervention. Careful preoperative imaging and vigilant follow-up with diuretic renography are essential.