Resection and release of fibrous tissue at the ureteropelvic transition

In the etiology of hydronephrosis, the obstruction of the renal pelvis-ureter junction is the most common, mostly caused by various congenital dysplasia. Most of the hydronephrosis in children and adolescents is this type. There are many specific causes of obstruction, but there are two types: 1 intraluminal stenosis, including dysplasia of muscle tissue, proliferation of fibrous tissue, diaphragmatic diaphragm, ureteral distortion with renal insufficiency, ureteral placement of renal pelvis The mouth is too high. 2 external pressure in the lumen, common with fibrous adhesions, abnormal renal blood vessels caused by the formation of kinks or flexion at the junction of the fistula. When the muscle fiber is dysplastic or lacking, the peristaltic wave conduction from the renal pelvis-kidney is blocked, which can be one of the important factors of obstruction of the fistula. The cause of this obstruction is often not single, but comprehensive. Therefore, in the surgical treatment of this obstruction, it is necessary to consider the removal of the organic obstruction seen by the naked eye, but also the possibility of neurotransmitter. In the past, various surgical methods have been designed to relieve this obstruction, but the choice of surgical procedure should be based on the lesion and the specific circumstances of each patient. In order to achieve the goal of completely eliminating obstruction in various operations, the following basic requirements must be met: 1. The newly formed lumen should reach the normal diameter. 2. The ureteral opening is at the lowest part of the renal pelvis and should be funnel-shaped. 3. Excision of excess tension-free renal pelvic wall, so that the renal pelvis cavity is reduced, and the wall contraction is strong. 4. The ureteral segment of the surgical department is engaged with the renal pelvis and is kept straight. 5. To prevent excessive exudate accumulation around the surgical area of the fistula, the inflammatory reaction is too large, try to reduce the proliferation of fibrous tissue around the ureter, and the subsequent adhesions cause poor emptying. The diagnosis has been confirmed, except for mild hydronephrosis, no obvious expansion of the renal pelvis, although the renal pelvis is suspected of obstruction, but the diagnosis is not clear, you can continue to observe regularly, and those who do not undergo surgery will need surgery to remove the obstruction. Especially for clinical symptoms, renal pelvis and renal pelvis have been significantly expanded, and progressive development, renal function has been damaged to varying degrees, or complicated by kidney stones, secondary infections, renal hypertension, it is more appropriate to take active surgical treatment. The following basic principles should be followed for the timing of the operation and the arrangement of the bilateral preoperative hydronephrosis: 1. Unilateral hydronephrosis or solitary kidney hydronephrosis, after diagnosis, surgery should be treated. If stones or infections are complicated, it will inevitably aggravate the destruction of kidney tissue, and it is imperative to remove the obstruction. 2. Both sides of the same degree of hydronephrosis, one side of the operation can be performed first, after a little recovery, the contralateral surgery is performed as soon as possible, and bilateral pyelo-ureteroplasty can be completed in one stage. 3. Bilateral obstruction, one side of the hydronephrosis is heavy and the renal function is obvious, and one side is light, then the side is the first, followed by the lighter contralateral side. 4. bilateral hydronephrosis, such as one side of the infection or stones, should first remove the obstruction, remove infection and stones. Although the contralateral water is heavier, it should be postponed. After the condition is improved, it should be treated as soon as possible to prevent the renal function recovery from affecting the antagonistic balance mechanism. 5. If long-term severe obstruction causes one side of the renal function to be destroyed and cannot be recovered, if the contralateral renal function is normal, nephrectomy will be performed. If the contralateral kidney is also obstructed, surgical treatment of functional hydronephrosis should be performed first, and non-functional nephrectomy should be arranged in the later stage. Before performing the operation, in addition to the preoperative preparation according to the general principles of kidney surgery, special attention should be paid to the special characteristics of the following preoperative preparations: 1. Patients with bilateral hydronephrosis or long-term repeated infection, often with anemia and hypoproteinemia, should be corrected and corrected before surgery. 2. Severe infection of hydronephrosis, such as short-term systemic anti-infective treatment can not be effectively controlled, can be timely drainage of renal pelvis decompression, the use of double "J" tube or percutaneous puncture pyogenic ostomy can achieve better results. A pyeloplasty or other procedure to relieve obstruction should be performed after the infection is completely controlled. 3. Megalohydronephrosis in child, which can occupy half of the abdominal cavity. If the abdominal pressure is too high, the renal ostomy can be performed first. After the condition is improved, the nephrectomy is determined according to the recovery of renal function and the degree of disease. Or pyeloplasty. 4. Long-term bilateral hydronephrosis, chronic renal insufficiency symptoms, correction of acidosis, imbalance of water and electrolyte balance and anemia, often require the implementation of bilateral bilateral renal pelvis surgery, to restore kidney function, After the whole body condition has improved, various operations to relieve the obstruction are performed. 5. In patients with obstruction of the junction and obstruction of the kidney, the renal pelvis-ureterplasty should be completed in the first stage while the stone is removed. Can not only pay attention to the stone and ignore the existence of obstruction, but also can not be satisfied with percutaneous nephrolithotomy and extracorporeal shock wave lithotripsy. There are many procedures for the choice of obstruction of the ureteropelvic junction. Although it can be predicted according to urography before surgery, what kind of surgery should be performed in each patient is often determined after the surgical exploration of the lesion is clear. In recent years, the fluoroscopy expansion of the pelvis and ureteral junction has the advantages of accurate positioning, good expansion effect, simple operation, short hospitalization time and small damage, which can be selected and applied. Treatment of diseases: ureteropelvic junction obstruction Indication The pelvic ureteral transitional fibrous tissue resection lysis is applicable to: The connective tissue band around the junction of the fistula can often cause the ureter to be confined, displaced, and twisted to cause obstruction. The fiber band can be surgically removed, and the ureter can be released freely, and the obstruction can be relieved. Gradually disappeared. However, this type of tube-fiber bandectomy is limited to a shorter course of disease, a lesser degree, a normal development of the ureter itself, and no significant stenosis in the lumen. Such cases are quite rare in clinical practice. The indications for this surgery should be strictly controlled. Surgical procedure The inferior pole, the renal pelvis and the upper ureter were exposed through the lumbar incision, and all the fibrous adhesions were separated and ligated, and the junction of the renal pelvis and ureter was completely freed. At this point, the compressed ureter can be seen to expand. As the corpus callosum contracts, the peristaltic wave is transmitted to the ureter through the renal pelvic opening, and the urine is transported downwards one by one. Touch the kidney fistula and ureteral cavity with your hand, the wall is thin and soft. If the renal pelvis contraction force is poor, it can be supplemented by vascular clamp stimulation, or rapid intravenous input of diuretic. When the full kidney tachycardia is empty, it means that the operation has been relieved, and it is not necessary to cut the renal pelvis for further treatment. . After the rubber band is drained in the operation area, the waist incision is sutured layer by layer.

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