Ureteral stricture resection and bladder anastomosis

One side of the kidney tuberculosis contralateral nephrotic contralateral hydronephrosis was first proposed by Wu Jieping in the 1950s, and later supplemented by others, so that its pathogenesis and surgical treatment principles and methods are perfected. This late complication accounts for about 16% of kidney tuberculosis patients. After clarifying this theory, some advanced patients in the past have received active treatment. The contralateral kidney and ureteral hydrops of one side of the renal tuberculosis can be caused by the following pathological changes: 1. Tuberculous cystitis with severe ureteral stenosis is healed and scarred, resulting in narrowing of the inner wall. 2, ureteral stenosis due to tuberculosis urinary continual reflux to the contralateral ureter, or lymphatic infiltration between the sheath, so that the lower ureter formed tuberculous stenosis. This narrow segment is generally within 5 cm of the end. 3, tuberculous contracture bladder internal pressure is often in a high pressure state, resulting in contralateral ureteral orifice dilatation - reflux, the formation of reflux renal, ureteral hydrops. 4, ureteral stenosis and regurgitation in the formation of ureteral scar stenosis, but also destroy the physiological closure function of the inner segment of the wall, become the common cause of this type of kidney, ureteral hydrops. Curing disease: Indication 1. The lesion is a scarring stenosis in the stationary phase of tuberculosis, and the length does not exceed 5 cm. 2. The inner segment of the bladder wall or the opening is narrow, and the treatment is ineffective by intravesical incision, dilatation, and stent tube drainage. Surgical procedure 1. Incision Good exposure was obtained in the lower stenosis with an oblique incision of the peritoneal diameter of the ankle (ie Gibson incision) or a rectal abdoministomy of the lower abdomen. Here the following abdominal oblique incision peritoneal outer diameter path is described. The incision begins at 3 cm from the inside of the iliac crest and is slanted down to the pubic symphysis parallel to the inguinal ligament. 2, cut the abdominal wall The skin, subcutaneous tissue, external oblique muscle aponeurosis, intra-abdominal oblique muscle and transverse abdominis muscle were sequentially cut in the direction of the incision, and a small incision was made on the transverse transverse fascia to see the extraperitoneal fat. 3, revealing the ureter The peritoneum is pushed up and down by hand to separate from the transverse fascia, and then the inferior oblique muscle and the transverse abdominis incision are enlarged to be as long as the incision. At this point, use the gauze to push the peritoneum up and you can see the iliac vessels. An expanded ureter can be found between the retroperitoneal and the iliac vessels according to their direction of travel, appearance, and peristalsis, and the ureter is lifted with a gauze band. 4, resection of the lesion ureter A segment of the fibrotic ureter is removed to allow an anastomosis with the bladder. If there is no tension in the anastomosis, the stenosis can only be removed by a maximum of 4 to 5 cm. If the ureter is slightly longer, the kidney and ureter need to be freed and pulled downward, or the top of the bladder can be pulled up and fixed. 5, ureteral bladder and then anastomosis The anastomosis of the ureter and the bladder is mostly performed by mucosa-to-mucosa. The first layer is anastomosed with a 4-0 absorbable line, and the eversion is intermittently sutured to avoid re-stenosis. The second layer is sutured with a silk suture to complete the posterior wall. After the anastomosis, the ureteral stent tube was placed, and the urethral catheter was taken out, and then the anterior wall was anastomosed. The surgical department placed a rubber tube for drainage and sutured the abdominal wall incision.