What Is a Pyeloplasty?

Ureter pyeloplasty, also known as pyeloplasty, is mainly used to solve the phenomenon of ectopic vascular connection between the patient's pelvis and ureter.

Ureteroplasty

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Ureter pyeloplasty, also known as pyeloplasty, is mainly used to solve the ectopic vascular connection of the patient's pelvis and ureter.

1. YV angioplasty with pelvic ureteral junction. Separate the renal pelvis and ureteral connection part. It should be noted that sometimes the external surface of the part is normal but actually still narrow. You can inject saline into the renal pelvis to see if it can be emptied. When the pelvis cannot be emptied, the upper part of the ureter below the pelvic ureteral junction should be cut open longitudinally, and probed upwards. Obstruction can be encountered at the pelvic ureteral junction. The incision is extended upwards, and the renal pelvis is opened in a Y-shape to expose and remove the fibrous muscle ring at the pelvic ureteral junction. The renal pelvis and the posterior ureteral muscular layer were intermittently sutured with a 4-0 chromium intestine. New and small mushroom-shaped urethral catheters and plastic tubes were introduced into the renal pelvis and ureter through a renal parenchymal incision respectively for pyelostomy. Finally, pull the tip of the triangular valve towards the ureter and suture,

1. The incision and the method of exposing the kidney and ureter are the same as the "YV" angioplasty of the pelvic ureter. After examining the renal pelvis and ureter to determine the nature and extent of the lesion, the ureter was cut under the obstruction.

2. Excessive renal pelvis is removed and the lower part is retained to form a "V" shaped renal pelvis. The base of the valve is wide and the length is appropriate to ensure blood supply and prevent apical necrosis. A wedge-shaped incision was made on the outside of the proximal end of the ureter. The length of the incision was equal to the length of the "V" flap.

3. Place a double "J" drainage tube and place one end into the bladder and the other end into the renal pelvis through the ureter. The lower corner of the "V" shaped valve corresponds to the lower end of the ureteral incision. The ureter and renal pelvis are sutured with a full-layer discontinuity using a 5-0 chrome bowel. The renal pelvis incision was sutured with 4-0 chromium intestinal sutures.

4. Cover the renal pelvis and ureteral incision with periprenal adipose tissue, place a cigarette roll beside the renal pelvis for drainage, and suture the incision in layers.

For ureteral pyeloplasty, different surgical methods should be selected according to the degree of hydronephrosis, renal function, the cause of stenosis, and the degree, position and length of the stenosis. If the hydronephrosis is not very severe, some renal functions should be preserved. Try to keep the kidney, especially nephrectomy in patients with hydronephrosis should be very careful. There are many ureteral pyeloplasty methods, including narrow section longitudinal incision and transverse suture angioplasty, "YV" angioplasty, pelvic ureterotomy or pyeloplasty, and ureteropelvic anastomosis.

The ectopic phenomenon of the connection between the renal pelvis and the ureter cannot be restored and is accompanied by significant hydronephrosis. When partial pelvic and stenotic lesions are removed, partial pyelectomy and pelvic ureteroplasty should be used. Preoperative preparation should be done before ureteroplasty to ensure the success of the plastic surgery. Urine is sterile. Unless acute obstruction occurs, it is unwise to perform hydronephrosis plastic surgery in the presence of infection, and appropriate antibiotics should be used to control bacterial urine based on the results of urine culture.

Preoperative care of ureteroplasty

1. Check the status of important organs of the body before surgery, especially renal function tests (usually including urine routine, blood urea nitrogen measurement, and phenol red test, etc.) to determine whether the healthy kidney can compensate urinary system function.

2. A pyelography must be performed before ureteroplasty to clarify the condition of the two kidneys. At the same time, the side of the diseased kidney should be checked repeatedly. For example, a newly discovered non-functioning kidney of intravenous pyelography can be caused by a disease, but It can be caused by the loss of contrast agent, or caused by temporary renal artery spasm, and it should be identified.

3. Necessary preoperative treatment should be performed before surgery. If kidney injury is combined with shock, it must be actively rescued. Renal tuberculosis should be treated with antituberculosis for a period of time (usually 2 weeks). Urinary infection should be controlled. Water and Electrolyte disorders should be corrected, and anemia and hypertension should be improved.

Nursing during ureteroplasty

1. Strict hemostasis must be performed during ureteroplasty to prevent clot formation in the renal pelvis, resulting in blood clots, extravasation of blood, and rupture of the shaped suture.

2. The causes that may cause obstruction of the pelvic ureteral junction, such as the removal of the fibromuscular hyperplasia ring of the pelvic ureteral junction, must be eliminated during ureteroplasty.

3. Place a plastic support catheter above and below the formation to ensure that it is unobstructed during and after the operation.

4. During the operation, a cigarette should be placed near the forming site to ensure that all the exuded liquid is drawn out to avoid accumulation.

Nursing after ureteroplasty

1. After 3 to 4 days after surgery, the Penrose drainage is removed. The mushroom catheter and plastic tube are left for at least 3 weeks, and the tissue is completely healed. Adjust the pH of the urine to make it acidic after surgery to reduce urine salt deposition. Pay close attention to the catheter and flush it 1 or 2 times a day to avoid clogging.

2. After 3 weeks after operation, perform a pyelography with a mushroom-shaped urethral catheter. If the contrast agent overflows, both the mushroom-shaped urethral catheter and the plastic support tube need to remain in place; if there is no overflow, the plastic tube can be removed After 2 to 3 days, try to clamp the mushroom-shaped catheter. If there is no pain on the side of the diseased side, there is no mass and temperature rise, you can remove the mushroom-shaped catheter. If the above symptoms occur, the mushroom catheter should be reopened for further examination of the cause and treatment.

3. Patients should be closely observed after wound healing, until urine culture becomes negative. Most postoperative pyelograms show good emptying of the pelvis and reduced hydronephrosis, but regular follow-up is still needed.

Ureter Pyeloplasty Diet Nursing

1. Eat more foods containing vitamin A, such as pork liver, eggs, and fresh cabbage and fruits.

2, eat less calcium-rich foods such as kelp, black fungus, beans, amaranth, milk, celery, laver, moray eel, salted radish, pumpkin seeds, dried red dates and so on.

3. Eat less oxalic acid-rich foods, such as spinach, celery, cocoa, coffee, beets, grass mold, oranges, sweet potatoes, black tea, and so on.

4. Eat less food that is likely to cause increased urate, cystine, and xanthine, such as animal offal, seafood, beans, and peanuts.