URINARY SYSTEM-1

A. Kidneys:
1. Lie in the retroperitonial space, lateral to aorta and CdVC.
2. Have fibrous capsule & are held in position by subperitoneal C.T.
3. Pelvis is funnel-shaped structure; receives urine and directs it
into the ureter.
4. Renal artery arises from dorsal aorta, normally bifurcates into
dorsal and ventral branches; however, variations are common.
B. Ureters:
Fibromuscular tubes, begin at renal pelvis, prox portion
retroperitoneal, distal portion peritoneal; enter the dorsal
surface of bladder obliquely.
Urinary System (cont)
C. Urinary Bladder:
1.Position varies with the amount of urine it contains
2.Main parts (Fundus, body, neck & Trigone area)
3.B.S from cranial & caudal vesicular arteries
4.Sympathetic innervation from hypogastric nerves
5.Somatic innervation to ext bladder sphincter & striated muscles of urethra from
pudendal nerve
D. Urethra:
6.From neck of bladder to the exterior
7.Somatic innervation from pudendal nerve
8.Divided into prostatic membranous and penile portions
Urinary System (cont)
Surgical Procedures:
1. Renal Biopsy (Needle & Wedge)
2. Nephrotomy
3. Nephrectomy (Total and Partial)
4. Pyelolithotomy
5. Ureterotomy
6. Ureteral Aanstomosis
7. Ureteroneocystostomy
8. Cystotomy
9. Urethrotomy
10.Urethrostomy
2. Nephrotomy:
Indications:
Renal calculi lodged in renal pelvis (most common) & Dictophyma renale
Surgical Tech:
• Midline laparotomy fro xiphoid to caudal to umbilicus
• Grasp peritoneum over caudal pole of kidney with tissue forceps and incise with
scissors
• Insert your finger into this opening & gently peel off the peritoneum
• Reflect perirenal fat from ventromedial surface of the hilus to expose renal vein
and ureter
• Lift the kidney from its bed, retract medially, reflect the perirenal fat from
dorsolateral surface to expose the renal artery
• Temporarily ligate the renal artery with a vascular forceps or Romel tourniquet
Nephrotomy (cont)
• Cut through renal parenchyma from cranial to caudal pole up
to the pelvis with a single incision without bisecting the kidney
• Remove calculus / parasites carefully with a forceps
• Close the incision with three equally spaced horizontal
mattress sutures through deep region of the renal cortex using
2/0 PGA. Use straight needle.
• Close capsule of the kidney with continuous suture line using
3/0 PGA.
• The sutures in the renal cortex and capsule should not be tight
• Remove the vascular forceps or the tourniquet, check for
bleeding, return kidney to N place and perform nephropexy
3. Nephrectomy:
Indications:
• Renal neoplasia
• Severe trauma (uncontrollable hemorrhage / urine
leakage)
• Pyelonephritis refractory to medical treatment
• Hydronephrosis
• Irreparable ureteral abnormalities
Note: Always assess the function of other kidney
before elective unilateral nephrectomy
Nephrectomy (cont)
Surgical Tech:
1. Dissect free the kidney from its sublumber attachments
and elevate it
2. Ligate the artery and the vein (Don’t ligate them
together)
3. Be careful in case of left kidney, as the left ovarian and
testicular veins drain into the renal vein
4. Ligate the ureter near the bladder
5. Remove the kidney and ureter
6. Close laparotomy incision
4. Pyelolithotomy
May be used to remove the calculus if the prox ureter and renal
pelvis are sufficiently dilated. Avoids trauma to renal parenchyma;
however, it is extremely difficult if the ureter is not dilated.
Surgical Tech:
1. Mobilize the kidney
2. Make incision over the dilated pelvis & prox ureter and remove
the calculi.
3. Flush the renal pelvis and diverticula with warm saline solution to
remove any debris
4. Close the incision in a continuous pattern using 4/0 or 5/0
absorbable suture.