输尿管造口术

Ureteroureterostomy is the technique of End-to-End Junction of the Ureter.

                               
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Indication for Ureteroureterostomy.
Communicating of tender portion less than 3 cm ureteral pathology of the mid and proximal ureter. Distal ureteral strictures are individual aerated with re-implantation of the ureter. Treatment of retrocaval ureter.

Contraindications.
Yearlong ureteral pathology or injuries, which do not reserve a tension-free end-to-end conjugation. Kidneys without enough role less than 15% of enumerate glomerular filtration appraise Implicit diseases with exuberant surgical seek, if a ureteral stent is an secondary.

Preoperative Unhurried Thought.
Exclusion or communication of a urinary pathway communication. Substance of a DJ ureter stent and insuring the diagnosis with decline pyelography, if achievable.
Perioperative antineoplastic prophylaxis. Substance of a transurethral catheter.

Surgical Act.
The operative attack to the proximal ureter is via a wing imprint. The mid-ureter and distal ureter is reached with retroperitoneal or transperitoneal lessen cavity incisions: e.g. paramedian laparotomy or Thespian prick. After remembering of the ureter with pathology or accident, the ureter is carefully unprotected. Atraumatic treatment and shelter of the vascular render is distinguished.

Colligation of the Ureter.
After remembering of the pathology or hurt, the unhealthy endeavour of the ureter is't distant. Both ends of the ureter moldiness be discharged of blemished tissue, with great vascular render and should be brought together without enmity.
The proximal and lateral end are spatulated nearly 7-10 mm at 180 degrees apart.

Position of a ureteral stent, if you eff not through preoperatively.
Crossing sutures are situated. Afterwards, the ureter colligation is realized by using the nook sutures lengthways sutura or in a interrupted trend.
Inclose a lesion drainage.
Scathe approaching.

Ureteroureterostomy.
both ends of the ureter are spatulated. After activity of intersection sutures, the conjunction is through in a streaming or interrupted pattern.

Generalized measures.
Other assemblage. Respiratory therapy. Thrombosis prophylaxis. Laboratory controls Hb. Lesion inspections.



Details of this Surgery.
00:01 Laparoscopic Transposition &
Ureteroureterostomy for
Retrocaval Ureter.

00:05Patient History
35 years male presented with complaint of..

Right flank pain for 1 year.

No haematuria.

No fever.

No dysuria.


00:16 On Examination.
Vitals Normal.

Right flank tenderness present
.
Suggestive of right hydronephrosis with
right upper urete.

00:30 CT scan showing.
Showing Retro Caval Ureter & IVC.

00:34 Hydronephrosis in right kidney with retro caval ureter.

00:37 Colonic Mobilization.

00:51 Dilated Proximal Ureter.

01:29 Proximal Dilated Ureter mobilized.

01:39 Distal Ureter Mobilized.

01:51 Retrocaval segment being dissected.

02:07 Completely mobilized retrocaval ureter and showing IVC.

02:33 Antegrade placement of guide wire.

02:50 Distal Ureter spatulated.

03:00 Antegrade stenting.

03:31 Proximal ureteric division.

03:51 Proximal ureteric spatulation.

04:36 Ureter completely divided.

04:44 Uretero ureteric anastomosis.

05:47 Excised segment of retrocaval ureter.

06:21 Anastomosis complete.

06:25 Post operative IVP.

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