Ureteronephrectomy
Introduction
- Removal of ureter and kidney.
Uses
- Gross trauma, eg crush injury, avulsion.
- Neoplastic lesions of kidney, ureter or adjacent organs Kidney: neoplasia Ureter: neoplasia.
- Ectopic ureter Ureter: ectopic if kidney irreversibly altered or ureteral anastomosis impractical Ureter: anastomosis , hydronephrosis Hydronephrosis / hydroureter.
- Cysts: solitary or multiple Kidney: polycystic disease.
- Idiopathic renal hematuria Hematuria.
- Dioctophyma renale
- Chronic pyelonephritis refractory to medical treatment Kidney: pyelonephritis.
- Ureteral abnormalities that defy surgical repair (stricture, rupture, avulsion Ureter: trauma ).
Advantages
- Relatively straightforward.
Disadvantages
- Must ensure that contralateral kidney function is normal.
Alternative techniques
Partial nephrectomy- Where viable renal parenchyma can be salvaged, eg crush injuries, cystic lesions, localized infections.
Time required
Preparation
- Routine surgical preparation - 30 min.
Procedure
- 1-2 hours depending on reason for removal of kidney/presence of adhesions.
Decision taking
Risk assessment
- In the days preceding surgery use available diagnostic means to evaluate contralateral kidney function (blood test, urinalysis, ultrasonography, pyelography, scintigraphy).
- If kidney neoplastic ensure that no metastases are apparent before surgery, ie lateral thoracic radiographs and ultrasound scan other kidney Kidney: neoplasia.
- In crush injuries check for other signs of trauma Ureter: trauma.
- Evaluate contralateral kidney function Renal function assessment :
- Urine specific gravity Urinalysis: specific gravity and serum[urea] and [creatinine] Blood biochemistry: urea Blood biochemistry: creatine phosphokinase (NB only abnormal if both kidneys have severely compromised function).
- Iohexol or exogenous creatinine clearance test Creatinine clearance - allow early diagnosis of renal insufficiency although not evaluating individual kidneys.
- Ultrasonography Ultrasonography: bladder and urinary tract.
- Radiography (intravenous urography Radiography: intravenous urography ) - crude evaluation of individual kidney function.
- Renal scintigraphy - the most accurate method for quantifying individual kidney function Scintigraphy: renal for GFR.
- Must be sure that removal of one kidney will not compromise animal's survival.
- In trauma cases ensure that cardiorespiratory problems are dealt with prior to surgery unless life-threatening hemorrhage.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Savvas I, Rallis T, Raptopoulos D (2009) The effect of pre-anesthetic fasting time and type of food on gastric content volume and acidity in dogs. Vet Anaesthes Analg 36 (6), 539-546 PubMed.
- Watson A D, Lefebvre H P, Concordet D et al (2002) Plasma exogenous creatinine clearance test in dogs: comparison with other methods and proposed limited sampling strategy. JVIM 16 (1), 22-33 PubMed.
- Lanz O I, Waldron D R (2000) Renal and ureteral surgery in dogs. Clin Tech Small Anim Pract 15 (1), 1-10 PubMed.
- Gookin J L, Stone E A, Spaulding K A et al (1996) Unilateral nephrectomy in dogs with renal disease - 30 cases (1985 - 1994). JAVMA 208 (12), 2020-6 PubMed.
- Lirtzmann R A & Gregory C R (1995) Long-term renal and hematologic effects of uninephrectomy in healthy feline kidney donors. JAVMA 207 (8), 1044-7 PubMed.
- Christie B A (1980) Collateral arterial blood supply to the normal and ischemic canine kidney. Am J Vet Res 41 (9), 1519-25 PubMed.
- Chew Q T & Madayag M A (1973) Post-nephrectomy arteriovenous fistula. J Urol 109 (4), 546-7 PubMed.