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
(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
The incision is closed in layers and the wound dressed.
3-19. KIDNEY TRANSPLANT
(1) This procedure involves the removal of a donor kidney by means of a
nephrectomy and ureterectomy with transplant of the donor's kidney in the recipient's
iliac fossa. This is done in an effort to restore kidney function and thus maintain life in a
patient who is succumbing to renal failure.
(2) The patient selected for kidney transplant is usually young, well
advanced in irreversible uremia, free of other significant disease or infection, and free of
obstruction in the lower urinary tract.
(3) A kidney replacement may be chosen from a living donor or from a
cadaver that is without disease and of the same blood group as the recipient. The ideal
living donor is an identical twin, although family members or other volunteers may be
(4) It is important that the time lapse between donor nephrectomy and trans-
plantation of the organ to the recipient be kept to a minimum. In living donors,
hypothermia may be used to reduce the oxygen requirements of the kidney.
b. Preparation. Two adjacent operating rooms are prepared for the surgery,
and the operations on donor and recipient proceed simultaneously. On a cadaver
donor, the supine position is used, and a disposable drape with a large fenestration is
used to provide adequate exposure for bilateral nephrectomies. For a living donor,
either the lateral or supine position may be used. The recipient lies in the supine