Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section Iii: operations on the kidney, ureter, and adrenal glands
3-17
3-17. NEPHROURETERECTOMY
a. General. This operation involves the removal of a kidney and the entire ureter that drains it. It is indicated for the presence of hydronephrosis, a hydroureter too damaged to repair, or carcinoma of the renal pelvis or ureter. This procedure usually requires two separate incisions, one in the flank and one in abdomen. Two separate instrument sets are not required, but a second skin preparation setup and set of sterile drapes are required.
b. Operative Procedure.
(1) The patient is placed in a lateral position. The kidney and upper ureter are exposed, as described for nephrectomy, freed from their supporting structures, and brought out of the wound, taking as much ureter as possible. The ureter is not cut at this time. The wound is drained and closed in layers, leaving the kidney and ureter outside the wound, and lightly dressed.
(2) Care must be taken not to contaminate the kidney, exposed ureter, and incision as the patient is repositioned in a supine manner.
(3) The abdomen is prepped, sterile drapes are applied, and an abdominal incision is made to expose the lower ureter and bladder. These structures are freed. The ureter and a small cuff from the bladder are removed.
(4) At this time, the kidney and entire ureter are gently pulled free through the flank incision.
(5) A Penrose-type drain or catheter is placed in the bladder, and it is closed with chromic suture number 2-0. The abdomen is closed in layers and both wounds are dressed with gauze sponges and abdominal pads.
