Antenatal Hydronephrosis

Question 1

Walk me through a dismembered pyeloplasty

Answer 1

1. Flank vs anterior subcostal incision
2. Identify renal pelvis and UPJ
3. Transect and excise UPJ
4. Satiate the ureter laterally , trim the redundant renal pelvis
5. Anastamose with running sutures - absorbable
6. Make sure to place stent (can do neph tube)
7. Leave JP drain!

Question 2

When can you not dismembered?

Answer 2

If long ureteral stricture. Can consider foley YV plasty or spiral flap - but cannot use in pts with crossing vessel.

Question 3

How old before consideration for robotic surgery?

Answer 3

6 months old.

Question 4

What are differentials for a patient with unilateral hydroureteronephrosis?

Answer 4

VUR, UVJ obstruction, ureterocele, ectopic ureter

Question 5

Give me Weigert Meyer Rule

Answer 5

Upper pole - UO is usually inferior and medial - outcomes are ureterocele, ectopic ureter

Lower pole - UO is lateral and superior - UPJO, VUR