Further Indications for the Percutaneous Surgical Technique on the Kidney
If the cause of a kidney stone is a stricture at the ureteropelvic junction, it is naturally advisable to correct the obstruction after the calculus has been removed. This can be done percutaneously using the so-called “intubated ureterotomy” method developed by Davis. The stricture, depending on its position, is split open with a special flexible ureterotome or with an optical (Sachse) urethrotome (Fig. 58). After the scar tissue is completely dissected, it is essential that every fiber be separated and that a stent be applied for 3 weeks until healing is complete. For strictures at the ureteropelvic junction, an intercostal percutaneous approach should be selected to allow easy placement of the urethrotome in the ureter later on. Before the ureterotomy is performed, a ureteral catheter is inserted retrograde into the kidney with the tip of the catheter projecting out of the percutaneous track. The catheter is thus used as a stylet guide, along which the ureterotomy is carried out. The stricture is opened with the optical urethrotome until fatty tissue can be seen along the entire length of the stenosis (Fig. 59). A thick catheter of at least 9 Fr. in diameter is attached to the tip of the catheter and is drawn approximately 15 cm into the ureter to serve as a stent. At about 17 cm, holes have to be cut on the sides with the Lüer forceps to allow drainage of the renal pelvis.
KeywordsCatheter Sodium Chloride Perforation Mitomycin Indigo
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