ABSTRACT
If no irreversible damage is present in the kidney or ureter (e.g. marked hydronephrosis or hydroureter) a ureterotomy is performed to remove the calculus, and ventral cystotomy is performed to remove the bladder stones and flush the ureters. An intraoperative view of hydroureter with multiple calculi is shown (14b). Treatment with antibiotics (based on culture and sensitivity) and appropriate diet modification (based on calculi analysis) is indicated. After two weeks of ureteral obstruction an affected kidney will regain only 50-60% of its pre-obstruction function. With severe ureteral dilation, hydronephrosis or pyelonephritis, ureteronephrectomy is considered. iv. Incise the ureter proximally because in most instances it is dilated and ureterotomy is easier; to close use simple interrupted or simple continuous sutures. Although gut, polyglycolic acid or polyglactin 9 have been used with success in the urinary tract, absorbable, 5-0 to 6-0, monofilament suture, such as polydioxanone (PDS, Ethicon) or polyglyconate (Maxon, Davis and Geck), with a swaged-on needle is recommended. These materials provide less tissue drag, better strength at a smaller size and varied pH, and induce less inflammation.
