ureteral hernia resection

Ureterectomy is used for the treatment of ureteral cysts. The end of the ureter bulges in the bladder as a cyst called a ureteral cyst. Mostly caused by congenital dysplasia, more common in children. The surface of the cyst is the bladder mucosa, and the inner layer is the ureteral mucosa, which is the muscle fiber and connective tissue. The cyst is spherical or oval. Some with the ureteral peristalsis, urine into the cyst and swell, and some can form a huge cyst, full of bladder, and occasional ureteral cyst can be protruded through the female urethra to the urethra. Curing disease: Indication 1. A ureteral cyst with good renal function should be treated surgically after diagnosis. 2, a huge cyst, caused by renal hydronephrosis combined with renal insufficiency, should first drain the renal pelvis, after the general condition of the sick child improved and then elective surgery. Preoperative preparation 1, taking the urinary X-ray film, to understand whether there are stones in the cyst; do excretory urography, to understand the functional status and the degree of water, to understand whether combined with ureteral malformation. 2, such as urinary tract infections exist, urine culture and drug sensitivity test should be done before surgery, select sensitive antibacterial drugs, from the beginning of surgery, continue to use after surgery. 3, such as cysts are too large, block the bladder mouth, causing renal dysfunction of the double ureteral hydrops, the catheter should be placed in the catheter before continuous drainage, until the general condition and renal function improved after elective surgery. Surgical procedure 1. Incision and incision of the inferior midline incision, from the pubic symphysis to the midpoint of the umbilicus, incision of the skin, subcutaneous tissue and abdominal white line, gently push the peritoneum upwards to reveal the anterior wall of the bladder with longitudinal vessels. Cut the anterior wall of the bladder longitudinally, absorb the liquid, and then use the scissors to enlarge the bladder incision. 2, cyst examination with a retractor to open the bladder wall incision, check the cyst for unilateral or bilateral and ureteral orifice of the wall. If it is unilateral, you should know the position of the contralateral ureteral orifice. 3. The wall of the capsule is used as a support line and a circular incision is made with a scalpel or an electric knife along the neck of the cyst. 4, from the bladder and outside the bladder with a hemostatic forceps and scissors to dissect the lower ureter. 5, with right angle pliers from the ureteral passage through the bladder wall to the outside of the bladder, push the peritoneum up, cut the bladder mucosa 3cm inside the original ureteral orifice, the right angle clamp tip separated into the bladder and clamped the catheter back into the bladder. 6. Suture the catheter to the ureter, with the catheter as a guide, and the ureter into the bladder through its new opening. 7. Close the muscle wall of the original ureteral orifice, use a pair of scissors and a hemostatic forceps to dissipate the submucosal tunnel, and pull the ureter through the tunnel. 8, cut off the extra ureter, ureter distal end with 4-0 flat or 5-0 chrome gut valgus and bladder anastomosis, if the ureter is very thick, you can first plasticize and then pass through the submucosal tunnel and bladder Match. 9. Place the balloon catheter through the urethra or the bladder on the pubis with a sacral catheter. The mucosa and submucosa of the bladder incision are sutured continuously with a 5-0 chrome gut. The bladder is sutured intermittently with a 2-0 gut. Muscle layer. The pubic posterior pubic space of the bladder was placed with a cigarette drainage, and the abdominal wall incision was layered and sutured. complication 1, bleeding It manifests as hematuria, and when it is severe, it forms a blood clot to block the drainage catheter. Mostly caused by ureteral bleeding, therefore, before the ureter and bladder anastomosis, the vascular of the proximal ureter should be freed and ligated with a 4-0 flat gut. 2, leakage of urine and urinary fistula formation A small amount of urine leakage after surgery can generally stop by itself. For example, the lower part of the ureter is shaped and the ureteral bladder anastomotic stenosis may cause leakage of urine for a long time to form urinary fistula. In order to prevent this from happening, the ureteral stent drainage tube can be placed for 2 weeks. 3, ureteral bladder anastomotic stenosis Postoperative renal and ureteral aggravation is caused by over-tightening of the ureteral anastomosis, new submucosal tunnel and ureteral transection through the muscular layer. Therefore, it should be noted that the bladder wall segment should be properly loosened around the ureter and temporarily placed if necessary. Ureteral stent drainage tube.