Pyeloplasty

Pyeloplasty is the procedure performed for the reconstruction of the obstructed Pelviureteric junction

Indication :
PUJ obstruction
PUJ injury
Neonatal hydronephrosis due to PUJ obstruction


Types
Anderson –Hynes dismembered pyeloplasty
Foley’s Y-V pyeloplasty
Culp – Deweerd procedure
Investigations
Clinical Investigation :
Renal function test
Urine routine
Urine culture
Serum creatinine and electrolytes
Blood routine
Blood biochemistry.

Radiological investigation:
X-ray KUB
IVU
Diuretic Renography
CT scan


Preoperative management:
Preoperative drainage of a kidney with PUJ obstruction is placed in case of infection associated with obstruction or azotemia from obstruction in a solitary kidney or bilateral disease.

Things :
1. BP handle –3,4,7 size
2. Forceps- Toothed -6”, 8”
Non Toothed –6”,8”
Vascular Forceps-6”-8”

3. Clamps:
• Mosquito curved artery forceps
• Mosquito straight artery forceps
• Medium curved artery forceps
• Medium curved artery forceps
• Allis tissue holding forceps
• Babcock forceps
• Sponge holder
• Right angle forceps
4. Needle Holder –6” and 8”
5. Retractors:
• Self retaining retractor
• Langenbeck retractor
• Deavers retractor
• Kellys retractor
• Morris retractor
6. Scissors:
a. Metzenbaum scissor
b. Mayo straight scissor
c. Angle pott’s scissor
3. Suction yanker
4. Towel clips
5. Cautery bag
Sutures:
• 2-0,3-0 free ties
• 2-0,3-0 chromic
• 4-0 vicryl
• 1 vicryl
• 2-0 ethilon
Miscellaneous things:
• Periosteal elevator
• Doyens’ rib raspirator
• Liston bone cutter
• Swedish bone nibbler


Surgical procedure:
Inj Gentamycin 80mg / Inj. Taxim / Inj Zostum
Anaesthesia
Under general anaesthesia
Position
Lateral position
Prone position
Different approaches includes:
An Anterior extra peritoneal approach
An Anterior trans peritoneal approach
An posterior lumbotomy
Extra peritoneal flank approach

Anderson- Hynes Dismembered Pyeloplasty:
It is the method of choice used for repairing the PUJ specifically regardless of whether the ureteral insertion is high on the pelvis or already dependent.
It reduces the redundant pelvis when necessary or straightening of a lengthy or tortuous proximal ureter.
Initially the proximal ureter is identified in the retreoperitoneum. Then the ureter is dissected cephalic towards the renal pelvis leaving a large amount of periureteral tissue to preserve ureteral blood supply.
A fine suture is placed on the lateral aspect of the proximal ureter below the obstruction and the medial and lateral aspects of the renal pelvis are delineated with traction sutures.
Then the PUJ is excised and the proximal ureter is then spatulated on its lateral aspect.
The apex of the ureteral spatulation is sutured to the inferior border of the pelvis while the medial side of the ureter is brought to the superior edge and anastamosed with fine interrupted (or) running absorbable sutures.
The internal stent drainage is placed.
A Retroperitoneal tube drain is also placed. Wound is closed in layer.