Operative note 22 Advanced

Pyeloplasty (Anderson-Hynes)

What it does: cut out the blocked PUJ and rejoin, wide.

Retroperitoneal cut under the 12th rib.
Find the ureter on psoas. Follow up to the pelvis. Do not strip its wrapper. That is its blood.
Stay stitch below the block. 2 stays on the pelvis.
Cut out the blocked segment and spare pelvis.
Spatulate the ureter's OUTER side (Potts scissors).
Join: spatula tip to low pelvis. Inner ureter edge to upper pelvis.
Water-tight 4/0 Vicryl.
Crossing vessel? Move the join in front of it.
Drain. Catheter out when dry.
Stent out at 4 weeks. MAG3 scan at 3 months. (MAG3 = a kidney drainage nuclear scan.)

Watch: In children: same steps. Smaller pelvis to trim. 3-4/0 or 5/0 stitches at the corners first.

From the UroRef Operative Quick Guide.