ureterocutaneous fistula

Ureteral ostomy is used for the surgical treatment of ureter and bladder diseases. Urinary diversion surgery is a procedure that changes the normal discharge of urine from the urethra. Urinary diversion surgery can be divided into temporary and permanent categories. In addition to kidney, ureter, bladder, urethroplasty (or ostomy), urinary diversion surgery is often used in the following ways: 1 using a segment of free intestinal tract in the abdominal wall to create a channel for urine flow. Such as ileal bladder surgery and controlled ileal bladder surgery developed on this basis. 2 urinary feces confluence surgery, such as ureteral sigmoid anastomosis. 3 In recent years, the development of urine flow does not change, and the use of intestinal tube for bladder replacement surgery, such as ileal bladder surgery. Ureteral ostomy is simpler than ileal bladder surgery. Its advantage is that it does not disturb the abdominal cavity, especially when the kidney is accompanied by ureteral dilatation. The shortcoming is that in a few cases, necrosis of the ureter can occur, resulting in stenosis and long-term indwelling of the drainage tube. Curing disease: Indication 1. Indications for temporary urinary tract surgery: Severe vesicoureteral reflux. 2 ureteral bladder obstructive disease. 3 refractory urinary tract infections. 4 certain urinary tract obstructive diseases. 2, permanent urinary diversion surgery indications 1 neuronal bladder. 2 ectopic bladder. 3 after cystectomy. Surgical procedure 1, incision: oblique incision in the lower abdomen, performed surgery through the extraperitoneal. If a cystectomy is required at the same time, a median or transverse incision in the lower abdomen is used. 2, in the lower part of the retroperitoneal ureter, pay attention to save its blood supply. The ureter was cut near the bladder, the distal end was ligated with a silk thread, and the proximal end of the drainage tube was inserted into the renal pelvis and fixed. 3. Pull the ureter at the level corresponding to the upper edge of the iliac crest. The muscles and aponeurosis through the site are cut vertically along the incision edge of the incision, but it is not appropriate to cut too much to avoid abdominal wall spasm. A 3 to 4 needle filament was passed through the ureteral adventitia to the external oblique aponeurosis. Suture the subcutaneous and skin incisions. 4, the ureter is turned into a nipple type, with silk thread and leather edge fixed suture. 5, if you need bilateral ureteral skin stoma, the opposite side can be carried out according to the same method. Because of the bilateral stoma, it is inconvenient for the sick child. The thinner side of the tube can be pulled to the opposite side through the anterior sigmoid and posterior sigmoid mesenteric, and the side ureter is end-to-side anastomosis, and then the skin is made. mouth. complication 1, the end of ureteral necrosis This is the most common complication, not only the end of the ureteral necrosis, but also the ureteral necrosis of the abdominal wall. Because of the end of ureteral artery infarction, therefore, pay attention to protect the blood supply of the ureter during surgery to prevent injury, pay attention to protect the ureter with wet saline gauze to prevent free ureteral dryness: pay attention to avoid the application of excessive ureteral drainage catheter to press the ureteral wall Causes ureteral ischemia, etc., can prevent complications of ureteral necrosis. 2, acute pyelonephritis Due to poor drainage of the ureteral drainage tube and retrograde infection. 3, ureteral skin fistula stenosis This is a common late complication. Light can be cured by dilatation, incision, and indwelling ureteral drainage tube for 4 to 6 weeks; severe cases must be corrected by surgery. Intraoperative ureteral defects can often be found. The ureter should be re-dissociated during surgery. The skin of the abdominal wall should be pulled out. If there is more ureteral defect, the ureteral skin can be re-selected according to the length of the ureter.