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.
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
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