Special Surgical Procedures II
LESSON 3: Procedures in Genitourinary Surgery
Section Iii: operations on the kidney, ureter, and adrenal glands
3-18
3-18. RECONSTRUCTIVE OPERATIONS ON THE KIDNEY
a. General.
(1) Pyeloplasty is a revision or reconstruction of the renal pelvis. It is done to create a better anatomical relationship between the pelvis of the kidney and the ureter and to relieve pain and obstruction to the flow of urine from the kidney. It may be necessary to ligate aberrant vessels, divide fibrous bands, resect stenotic areas, or reconstruct a redundant kidney pelvis to accomplish this and prevent or relieve hydronephrosis and hydroureter.
(2) Ureteroplasty is a reconstruction of the ureter, usually at the ureteropelvic junction.
(3) A Foley-Y pyelouretero-plasty may combine correction of a redundant kidney pelvis with resection of a stenotic area of the ureter.
b. Operative Procedure.
(1) The kidney and upper ureter are exposed, as for nephrectomy (refer to paragraph 3-14), using the desired approach.
(2) The kidney pelvis and ureter are incised, trimmed, and shaped to the desired contour, using fine forceps and scissors. A caliper and a ruler may be used for establishing more precise relationships to improve urinary drainage. Anchoring sutures or soft rubber drains may be used for traction during handling and repair. The repair is completed using fine sutures and needles, as specified by the surgeon. The technique used is designed to provide a direct funnel- shaped enlarged outlet. The Foley Y-V plasty technique may be used for this purpose. It converts a Y-shaped incision into a V-shaped one by resecting the redundant tissue between the arm and the stem of the Y. Fine, interrupted stitches are placed to make the repair. Stenotic areas of the ureter are excised as necessary and the ureter anastomosed with fine, everting stitches (ureteroureterostomy).
(3) A nephrostomy tube may be placed through a stab wound in the renal parenchyma. A splinting latex catheter 8 or 10 Fr may be placed to extend along the nephrostomy drain through the kidney pelvis and into the ureter beyond the site of the plastic repair.
(4) The incision is closed in layers and the wound dressed.
