By René Küss, Christian Chatelain (auth.)
There has been nice development in ureteral surgical procedure within the final two decades. The important indication remains to be calculous obstruction yet reparative and cosmetic surgery of the ureter for congenital and bought lesions are one of the finest advances in glossy urology. the fundamental aim of this surgical procedure is to make sure unfastened stream of the urine from the kidney to the bladder and in an effort to shield or increase kidney functionality that is regularly affected or threatened through any disorder within the excretory pathway. the fitting is to re-establish a closed circuit circulation from kidney to bladder by way of fix or substitution of the ureteral conduit so one can steer clear of so far as attainable the dis skills that end result from diversion of the urine to the surface floor or to the gut. This target can now be completed within the therapy of lots of the illnesses of the ureter whilst the appropriate kidney is satisfactorily fit to advantage conserva tion. The ideas used are usually not unavoidably new however the introduction of antibiotics has made it attainable to prevent or decrease the dangers of an infection, pyelonephritis, or pyonephrosis that so frequently advanced such surgical procedure in prior instances. development within the research of renal functionality and of the excretory tract has introduced a greater realizing of the physio-pathology of the urinary equipment and extra actual judgement of the result of reparative surgery.
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Extra info for Surgery of the Ureter
Sample text
September, 1967: destroyed left kidney removed. Biopsy of retro-peritoneal tissue revealed benign liposcIerosis. P. (75mins) (a). 6mg per 100ml. January 1969: Ureterolysis with intra-peritonealisation of the right ureter. March 1973: Condition excellent. P. (30 mins) (b). Urine sterile. 0 mg per 100 ml discolored, poorly vascularized and inert. Either way, if such a ureter is placed within the peritoneal cavity there is a risk of fistula with an intraperitoneal urinary leak. Resection of an isolated segment is sometimes possible but under these conditions the surgeon may hesitate to intraperitonealize the ureter.
Uretero-calyceal anastomosis with lower polar nephrectomy (continued). Renal and ureteral sections a cystoscope. If the kidney is very dilated, this drainage may not be adequate and then a temporary nephrostomy may be indicated, using a multi fenestrated silastic tube in addition to the ureteral catheter placed as a ureterostomy in-situ or across the kidney substance. A catheter of the Cummings type may also be used. 48 IV. Ureteral Anastomosis Fig. 43. Uretero-calyceal anastomosis with lower polar nephrectomy (concluded).
Suture b) Modifications This is the standard technique. Numerous modifications are possible, according to the position of the new meatus, the method of approach, the type of drainage and the length of the ureter. Position of the New Meatus It has long been thought that it was advisable to place the ureter in the trigone, the fixed part of the bladder, as close as possible to the natural meatus. In fact the ureter can just as well be implanted into the mobile part of the bladder, on the lateral wall or even the dome, with excellent results.