SURGEON'S WORKSHOP

RAPID URETERAL STENTING FOR REIMPLANTATION AND MID OR LOW URETEROURETEROSTOMY EUGENE V . CATTOLICA, M .D. From the Department of Urology, Kaiser-Permanente Medical Center, Oakland, and the Division of Urology, Department of Surgery, University of California Medical Center, San Francisco, California

Ureteral stenting is commonly employed for ureteral reimplantation and ureteroureterostomy . The stenting technique described here is easy and effective, and has been used in more than 30 operative procedures . From a Cystocath kit,* a 55-cm ., 8 F catheter, a 10-gauge trocar and cannula, and a three-way *Dow Corning Corporation, Midland, Michigan .

connector are selected (Fig . 1) . Occasionally 5 F tubing is preferable . Ureteral reimplantation For ureteral reimplantation, after the ureter has been sutured in its new location, and the self-retaining retractor is removed, the trocar and cannula are inserted through the abdominal wall into the perivesical space as a stab wound below

FIGURE 1 . Silastic tubing attached to three-way connector and passing through cannula from which trocar has been removed,

UROLOGY

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JULY 1975

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89

Drawing showing (A) placement of Silastic stent through trocar into perivesical space . Clamp grasps stent via stab wound in line with left ureter . (B) Shows stenting of completed bilateral ureteral reimplantation . FIGURE 2 .

the usual transverse incision . It is important to guard the organs subjacent to the abdominal wall with a malleable retractor. The tip of a mosquito or tonsil clamp is thrust through the contralateral wall of the bladder at a point in line with the new ureteral tunnel and adjacent to the vesical neck (Fig . 2A) . With this clamp, the Silastic stent is grasped, drawn into the bladder, inserted up the reimplanted ureter, and sutured in place at the skin . The upward vector of force is thus imparted to the contralateral stab wound in the bladder rather than the new submucosal tunnel, as would occur if the stent were brought out through the main cystostomy . Stenting may be performed bilaterally, the two stents crossing one another over the distal part of the trigone (Fig . 2B) . The tubing is connected to the three-way connector, which may be attached to closed-system urinary drainage (Fig . 1) . The stent is removed after five days following ureteral reirnplantation, and cultures of urine from the intubated side have invariably been 90

sterile; no antibiotics were given postoperatively . Rarely, proteinaceous material or blood has plugged the stent, but this has been easily irrigated via the three-way adapter, using sterile technique . Ureteroureterostomy For ipsilateral mid or lower ureteroureterostomy, the stent has occasionally been placed through a ureterotomy incision distal to the anastomosis, where it provides both stenting and urinary drainage . Comment This method of ureteral stenting employs a readily available, nonreactive Silastic catheter which allows easy connection to a closed-drainage system . Catheter irrigation may be performed without breaking sterile connections . The Permanente Medical Group 280 West MacArthur Boulevard Oakland, California 94611

UROLOGY

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JULY 1975 / VOLUME VI, NUMBER 1

Rapid ureteral stenting for reimplantation and mid or low ureteroureterostomy.

SURGEON'S WORKSHOP RAPID URETERAL STENTING FOR REIMPLANTATION AND MID OR LOW URETEROURETEROSTOMY EUGENE V . CATTOLICA, M .D. From the Department of U...
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