PLASTIC SUOERY ON RENAL PELVIS WITH SPECIAL CONSIDERATION ON ITS INDICATION

Abstract

The causes of hydronephrosis submitted to plastic surgery in Japan are in majority of cases the stricture and abnormal vessel at the uretero-pelvic juncture (UPJ) (Tab. 2).
In the cases with abnormal vessel many a clinic in Japan choice the pyelo-ureteral plasty rather than the dissection of the vessel (Tab. 4). As to the technique of plasty Foley's Y-plasty is performed most often with fairly good results (Tab. 3). But it cannot always relieve the impaired hydronephrotic kidney as seen in the world literatures. The simpler method of v. Lichtenberg (Fig. 1), as was performed in the authors own 5 cases (Tab. 7; Fig. 2-4), proves also to be well to obtain good results as far as recovery of the function of the kidney and the upper urinary tracts is concerned.
To obtain a good result by plasty in hydronephrosis it is essential to establish proper indication for it. For this purpose it was studied clinically on several points: pyelograms, renal function by the method of intravenous pyelography, renal aortograms, open biopsies of the kidney, renal infection and movement of renal pelvis and ureter, before operation, and discussed here. Further, necessities of resection of the dilated pelvic wall was discussed.
The author has been reached to the conclusion, at present, that in the cases which have E-grade (according to the graduation made by Huzino in the authors clinic) hydronephrosis judged from the retrograde or percutaneous punctuating pyelogram, and in which any calyceal shadow in 60-minute delayed intravenous pyelogram, was displayed, and further when they show any movement rontgen-kymographially in the upper urinary tracts, the plastic surgery is indicative. Of course, the existence of renal infection should be considered. But, it is not wise to abandon plastic surgery because of intensive turbidity (pyuria) of the renal urine. Percutaneous renal biopsy, if possible, may help the selection. Though there is no necessity of resection of the dilated pelvic wall in up to D-grade hydronephrosis, it may promote the improvement (Fig. 7). The technique of plasty would be selected as on prefers. The essentials for the plasty are to recover and insure the smooth flow of urine and not necessarily to make better the cosmetic appearance.