ureteral transplantation

Ureteral transplantation for surgical treatment of vesicoureteral reflux. The ureteral junction has a valve function. When the bladder pressure increases, the normal ureteral junction can prevent retrograde reflux of the bladder urine to the ureter. When the ureteral junction is insufficiency, different degrees of vesicoureteral reflux can occur, resulting in ureteral dilatation, and even hydronephrosis, renal parenchyma thinning, especially in the case of infection of the lower urinary tract, vesicoureteral reflux can cause acute Pyelonephritis. Recurrent episodes of hydronephrosis plus pyelonephritis often cause severe damage to renal parenchyma and kidney function. Curing disease: Indication Ureteral transplantation for severe ureteral ureteral ureteral dilatation. Preoperative preparation 1, preoperative excretory bladder urethra angiography, urodynamic examination, bladder urethra microscopy, double kidney B ultrasound, etc., to clarify the primary or secondary vesicoureteral reflux, if the secondary should first treat the primary disease . 2, do urine routine and urine bacterial culture, drug sensitivity test, if there is a urinary tract infection, should choose sensitive antibiotics to control infection. 3, check blood urea nitrogen, creatinine, etc. to understand the renal function, such as severely impaired renal function, you can first indwell the catheter to continue drainage, after the kidney function improved, and then surgery. Surgical procedure 1. Incision: Take a low pubic transverse incision so that the future incision scar is located in the pubic pubic hair. 2, revealed: open the skin and subcutaneous tissue, reveal the rectus sheath, separate the rectus abdominis from the midline, push the peritoneum up, cut the bladder longitudinally, open with a ring pull, use 3-0 or The 4-0 silk sutures the lowest position of the bladder incision and lifts it up to help reveal, prevent the incision from tearing down to the urethra and facilitating the suture closure at the lowest incision of the bladder. Check the number, position and shape of the ureteral orifice. , creeping off the situation and measuring its tunnel length. The ureter was inserted into the ureter with a thin catheter No. 3 or No. 5 and sutured. Make a circular incision around the ureteral orifice. 3. Anatomy: Carefully dissect the ureter along the annular incision around the ureteral orifice, generally starting from the lower part of the ureteral orifice, entering the level between the bladder muscle layer and the ureter, and then separating the ureter completely. Be careful not to damage the ureteral blood vessels and muscle layers when dissociating. In addition, when the ureter is free, pay attention to push the peritoneum close to the front. In men, care must be taken to prevent damage to the vas deferens. The contralateral ureter was removed in the same way. 4. Insert the No. 8 catheter into the ureter and fix it. Free the ureter from the bladder. If it is difficult, it must be combined with the external anatomy of the bladder to straighten the free ureter, but pay attention to retain the blood supply to the ureter. Prepare to remove the over-expanded ureter according to the dashed line, including the ureter that is too long and narrow. 5. Use 3 tissue clamps to clamp the excess ureter. 6, with 4-0 flat or 5-0 chrome intestine continuous suture reconstruction of the ureter, some scholars like to add a few needles intermittent varus suture to prevent ureteral rupture. The reconstructed ureter can be replanted by surgery through the bladder. complication 1, leaking urine Cases in which the ureter itself is shaped are more likely to occur. Generally, as long as the ureteral stent drainage tube and the bladder fistula tube are circulated for a few days, they will stop by themselves. 2. Urinary fistula formation Leaking urine for a long time can form urinary fistula, mostly caused by distal ureter ischemic necrosis. Therefore, attention should be paid to maintain ureteral blood supply during operation, and the stent drainage tube should avoid excessive pressure on the ureteral wall to affect blood circulation. 3, infection Including wound infections and acute pyelonephritis. In order to avoid pyelonephritis caused by retrograde infection, if the ureter itself has not undergone plastic surgery, the stent drainage tube can not be placed. If the ureter itself has been used for incision or plastic surgery, the stent drainage tube should be placed, and the internal drainage method should be adopted, that is, the double "J" shape The tube is placed in the renal pelvis and left in the bladder.