Operations On The Kidney And Ureter....
The surgeon approaches the kidney either through the loin or through the abdomen. The after-care of patients who have been operated on via the abdomen does not differ from that after any other laparotomy. The loin incision is made just below the twelfth rib, or through the bed of the rib after its resection.
The upper end of the ureter is approached through the loin, but the lower half requires an incision in the lower anterior abdominal wall, either an oblique one in the iliac fossa or a vertical paramedian.
Loin incisions are painful and adequate analgesia is vital. The patient should sit well up in bed and be encouraged to take deep breathing exercises and to cough in order to prevent pulmonary segmental collapse. Early mobilization is encouraged. The stitches are removed about eight or ten days later.
Almost always the wound is drained, usually with a corrugated rubber drain. The drain can be removed after 48 hours. Any operation involving an incision with subsequent repair in the urine-conducting channels— calyces, pelvis, ureter—may result in a leak of urine. If no ieak c ccurs, the drain may be removed in 48 hours; if there is a leak, the drainage should be maintained for at least 24 hours after it has dried up.
Nephreetomy, the removal of a kidney, is performed by mobilizing the kidney, and clamping, ligating and dividing the artery, vein and ureter.
Partial nephrectomy may be required for the removal of a grossly destroyed or distorted segment of kidney involved in calculous disease, in order to prevent stones forming again in the diseased area. The renal pedicle is temporarily occluded with a soft clamp, the diseased portion excised, and the wound in the kidney and pelvis sutured. Reactionary haemorrhage is a particular risk of this operation, and the blood pressure should be monitored hourly leor the first 12 hours.
Other conservative operations upon the kidney are the removal of stones through an incision in the kidney, nephrolithototny, or in the pelvis, pyelolithotomy, and a plastic reconstruc¬tion of the pelvi-ureteric junction (pyeloplasty) in the treatment of hydro¬nephrosis. Ureterolithotomy is the removal of a stone from the ureter.
A nephrostomy, or opening into the kidney, is a drainage tube connecting the renal collecting system to the exterior h, order to divert the urine flow permanently or temporarily. Indications are obstructive lesions affecting the ureter, or the necessity to protect a suture line in the collecting system (as for example after pyeloplasty) by reducing the flow of urine through the anastomosis. A nephrostomy tube inserted for the latter reason is usually
OPERATIONS ON THE KIDNEY AND URETER
removed about the eighth day, by which time the anastomosis should have healed.
All operations on the urinary tract, if the urine is infected, are liable to the infective complications of surgery—wound infection, sub-phrenic abscess, etc. Most surgeons believe in starting suitable antibiotics or chemotherapy, to which the organisms grown from a mid-stream specimen of urine are sensitive, before operation, and continuing for at least five days afterwards.
The surgeon approaches the kidney either through the loin or through the abdomen. The after-care of patients who have been operated on via the abdomen does not differ from that after any other laparotomy. The loin incision is made just below the twelfth rib, or through the bed of the rib after its resection.
The upper end of the ureter is approached through the loin, but the lower half requires an incision in the lower anterior abdominal wall, either an oblique one in the iliac fossa or a vertical paramedian.
Loin incisions are painful and adequate analgesia is vital. The patient should sit well up in bed and be encouraged to take deep breathing exercises and to cough in order to prevent pulmonary segmental collapse. Early mobilization is encouraged. The stitches are removed about eight or ten days later.
Almost always the wound is drained, usually with a corrugated rubber drain. The drain can be removed after 48 hours. Any operation involving an incision with subsequent repair in the urine-conducting channels— calyces, pelvis, ureter—may result in a leak of urine. If no ieak c ccurs, the drain may be removed in 48 hours; if there is a leak, the drainage should be maintained for at least 24 hours after it has dried up.
Nephreetomy, the removal of a kidney, is performed by mobilizing the kidney, and clamping, ligating and dividing the artery, vein and ureter.
Partial nephrectomy may be required for the removal of a grossly destroyed or distorted segment of kidney involved in calculous disease, in order to prevent stones forming again in the diseased area. The renal pedicle is temporarily occluded with a soft clamp, the diseased portion excised, and the wound in the kidney and pelvis sutured. Reactionary haemorrhage is a particular risk of this operation, and the blood pressure should be monitored hourly leor the first 12 hours.
Other conservative operations upon the kidney are the removal of stones through an incision in the kidney, nephrolithototny, or in the pelvis, pyelolithotomy, and a plastic reconstruc¬tion of the pelvi-ureteric junction (pyeloplasty) in the treatment of hydro¬nephrosis. Ureterolithotomy is the removal of a stone from the ureter.
A nephrostomy, or opening into the kidney, is a drainage tube connecting the renal collecting system to the exterior h, order to divert the urine flow permanently or temporarily. Indications are obstructive lesions affecting the ureter, or the necessity to protect a suture line in the collecting system (as for example after pyeloplasty) by reducing the flow of urine through the anastomosis. A nephrostomy tube inserted for the latter reason is usually
OPERATIONS ON THE KIDNEY AND URETER
removed about the eighth day, by which time the anastomosis should have healed.
All operations on the urinary tract, if the urine is infected, are liable to the infective complications of surgery—wound infection, sub-phrenic abscess, etc. Most surgeons believe in starting suitable antibiotics or chemotherapy, to which the organisms grown from a mid-stream specimen of urine are sensitive, before operation, and continuing for at least five days afterwards.
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