Kalabhavi Srinivas K.pdf

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MANAGEMENT : Surgical management : Proforma The evolution in the surgical correction of UPJ obstruction has occurred on a number of fronts, with open surgical techniques yielding way to endoscopic and laparoscopic approaches. Although there are a variety of surgical approaches to correction of UPJ obstruction, they can be classified into 3 categories. 1. Open surgical procedures. 2. Endoscopic (antegrade or retrograde) procedures. 3. Laparoscopic procedures. 1. OPEN SURGICAL PROCEDURES: The open surgical techniques that have the greatest applicability can be classified into 3 main groups. a. The dismembered pyeloplasty b. Flap procedures c. The incisional - intubated type The Anderson-Hynes pyeloplasty (1949) has become the most commonly employed ‘open’ surgical procedure for the repair of UPJ. Open pyeloplasty for correction of UPJO remains the gold standard against which all alternative therapies are compared. The overall success rates of open pyeloplasty range from 90-100% 28,29 . The technique of dismembering the ureter was borne out of necessity in the repair of retrocaval ureter (Anderson and Hynes, 1949). There was reluctance on the part of surgeons elsewhere because of concerns about severing the neural continuity
Proforma between pelvis and ureter. Later work demonstrated that the bolus of urine is the peristaltic stimulus. The principal reasons for the universal acceptance of the dismembered pyeloplasty are: Broad applicability, including preservation of anomalous vessels. Excision of the pathologic UPJ and appropriate repositioning and Successful reduction pyeloplasty. Indications for intervention: Presence of symptoms associated with the obstruction. Impairment of overall renal function or progressive impairment of ipsilateral renal function. Development of stones or infection, rarely, causal hypertension. A. DISMEMBERED PYELOPLASTY 3 : This operation is easy to perform and can be accomplished by following surgical approaches. Anterior subcostal Flank incision Posterior lumbotomy The actual repair for the modified Anderson-Hynes dismembered pyeloplasty, as performed through an anterior subcostal incision, is explained in materials and methods section.
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 and 16: 16 Insertion of trocar and laparosc
Page 17 and 18: INTRODUCTION Proforma Many treatmen
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: Whitaker test 3 : Proforma First de
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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