Kalabhavi Srinivas K.pdf

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LIST OF PHOTOGRAPHS XVI Contd… S. NO Topic Page No 18 Pelvis being opened with guidewire being seen 19 Reconstruction of UPJ 72 20 Reconstruction of UPJ being completed 73 21 Completed laparoscopic pyeloplasty with a drain through one of the port site 22 Preoperative renal scientigraphy showing reduced renal function in the left kidney 23 Postoperative renal scientigraphy showing 24 improved renal function in the left kidney Showing postoperative scar after 3 months in open and laparoscopic pyeloplasty done in a same patient who had bilateral PUJO 72 73 75 75 76
INTRODUCTION Proforma Many treatment options exist for the management of UPJ obstruction. Open pyeloplasty has high success rate & has been considered the gold standard. But there is a significant postoperative pain & long recovery time in open pyeloplasty surgeries. In an attempt to minimize the post-operative morbidity of open surgical UPJ correction many minimally invasive options have been developed. These include balloon dilation, antegrade endopyelotomy, retrograde endopyelotomy, Acucise endopyelotomy and Laparoscopic pyeloplasty 1 . During last decade, advances in endourological techniques have resulted in significant progress in the development of minimally invasive surgical procedures to treat UPJ obstruction. UPJ is the most common site of upper urinary tract obstruction occurring in 1 in 1500 births. The historical aspects of UPJ repair were reviewed by Kay in 1989 & Schaeffer & Grayhack in 1986. The first reconstructive procedure was performed by Trendelenberg in 1886, although patient died of postoperative complications. Kuster is credited with the first successful open pyeloplasty (1891). In 1892 Frenzer, applied the Heineke-Mikulitz principle for reconstruction of the UPJ 2 . Flap techniques were introduced by Schwyer in 1916. His Y-V pyeloplasty was then modified successfully by Foley in 1937. Spiral flap of Culp DeWeerd (1951), the vertical flap of Scardino & Prince (1953), Thompson & colleagues (1969) renal capsular flaps developed later in 1949. Anderson & Hynes, two English surgeons described their modification of Kusters dismembered procedure that involved anastomosis of the spatulated ureter to a projection of the lower aspect of the pelvis after a redundant portion was excised 2 .
Page 1 and 2: A PROSPECTIVE RANDOMIZED CONTROLLED
Page 3 and 4: RAJIV GANDHI UNIVERSITY OF HEALTH S
Page 5 and 6: RAJIV GANDHI UNIVERSITY OF HEALTH S
Page 7 and 8: I shall also remain grateful to Dr.
Page 9 and 10: LIST OF CONTENTS S. No Topic Page N
Page 11 and 12: LIST OF TABLES Table No. Topic Page
Page 13 and 14: LIST OF GRAPHS Graph No. Topic Page
Page 15: 16 Insertion of trocar and laparosc
Page 19 and 20: AIMS AND OBJECTIVES Proforma To com
Page 21 and 22: Proforma ously and independently su
Page 23 and 24: Proforma Although a variety of proc
Page 25 and 26: Proforma The UPJ is formed during t
Page 27 and 28: Renal Gonadal Aortic Common, iliac
Page 29 and 30: Physiology: Proforma The origin of
Page 31 and 32: Proforma The presence of these kink
Page 33 and 34: II) Secondary or acquired causes of
Page 35 and 36: Diagnosis: Proforma The diagnosis
Page 37 and 38: 2. Renal ultrasound (USG) 3 : Profo
Page 39 and 40: 3. Magnetic resonance imaging (MRI)
Page 41 and 42: Proforma PHOTOGRAPH 5 : RENAL SCIEN
Page 43 and 44: Processing: Proforma From the dyna
Page 45 and 46: Whitaker test 3 : Proforma First de
Page 47 and 48: Proforma between pelvis and ureter.
Page 49 and 50: Accessory lower pole vessel Anastom
Page 51 and 52: Selected published experience with
Page 53 and 54: Proforma The pelvic flap and ureter
Page 55 and 56: Proforma be bridged. The longer the
Page 57 and 58: Proforma A flap is outlined as desc
Page 59 and 60: Proforma mised and the contralatera
Page 61 and 62: Proforma Badlani and Coworkers 30 .
Page 63 and 64: Complications : Proforma 1. Hemorrh
Page 65 and 66: C. Ureteroscopic Endopyelotomy : Pr
Page 67 and 68:
Contraindications : Proforma Specif
Page 69 and 70:
Proforma POSTNATAL MANAGEMENT OF AN
Page 71 and 72:
Proforma patients diagnosed in infa
Page 73 and 74:
MATERIALS AND METHODS Proforma The
Page 75 and 76:
The following investigations were d
Page 77 and 78:
1. ANDERSON-HYNES DISMEMBERED OPEN
Page 79 and 80:
Proforma A Penrose drain is placed
Page 81 and 82:
Proforma PHOTOGRAPH. 9 : DISMEMBERE
Page 83 and 84:
Proforma PHOTOGRAPH. 13 : INCISION
Page 85 and 86:
Proforma passed though the proximal
Page 87 and 88:
Proforma PHOTOGRAPH 16 : INSERTION
Page 89 and 90:
Proforma PHOTOGRAPH 20 : RECONSTRUC
Page 91 and 92:
Proforma PHOTOGRAPH 22 : PREOPERATI
Page 93 and 94:
ASSESSMENT OF SUBJECTIVE OUTCOME :
Page 95 and 96:
FIGURE No. 11 : PICTORAL ANALOG PAI
Page 97 and 98:
Laterality : Proforma Out of 15 pat
Page 99 and 100:
Symptoms : Proforma Most patients p
Page 101 and 102:
Table No. 6 : Postoperative complic
Page 103 and 104:
Table No. 7 : Renal function on ren
Page 105 and 106:
Proforma Table No. 8 : Renal functi
Page 107 and 108:
Proforma Table No. 9 Preoperative a
Page 109 and 110:
DISCUSSION Proforma Gold standard f
Page 111 and 112:
Proforma Soulie et al 56 , reported
Page 113 and 114:
Proforma not significant (P=0.69885
Page 115 and 116:
Proforma The mean time when oral fe
Page 117 and 118:
SUMMARY AND CONCLUSIONS Proforma UP
Page 119 and 120:
The advantages of laparoscopic pyel
Page 121 and 122:
BIBLIOGRAPHY Proforma 1. Single cen
Page 123 and 124:
Proforma 19. Williams DI, Kenawi MM
Page 125 and 126:
Proforma 38. Lachevallier E, Eghaza
Page 127 and 128:
Proforma 57. Laparoscopic versus op
Page 129 and 130:
Background: ABSTRACT Proforma Urete
Page 131 and 132:
Proforma approach. Hospital stay an
Page 133 and 134:
4. HIV : HBSAg : 5. X-ray KUB Findi
Page 135 and 136:
ASSESSMENT OF OBJECTIVE OUTCOME a.
Page 137:
91 1.Pain PREOPERATIVE AND POSTOPER
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