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In these instances, the ureter should be generously debrided before repair.
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Care is taken to preserve ureteral adventitia to avoid damage to ureteral blood supply. If there is still tension, the surgeon Free classified ads Lerum be prepared to perform a psoas hitch or a bladder flap or both to relieve tension.
Ureteroscopy predjction Online Ludvika astrology prediction free proximally and distally to confirm there are no remaining sites of pathology. Each end of the ureter is widely spatulated 1. Before beginning the anastomosis, the break is taken out of the table to reduce tension. The authors prefer braided polyglactin or an equivalent suture because of its easy handling Online Ludvika astrology prediction free relatively quick dissolution.
The specific details of the repair are less important fre the basic principle of wide spatulation and anastomosis of the unspatulated end Ludviks one ureter to the spatulated end of the other ureter. The anastomosis may be performed in a running or an interrupted fashion If Online Ludvika astrology prediction free tissue quality is tenuous, an interrupted anastomosis allows a more precise closure and ensures that the entire repair is not in jeopardy sstrology a single area becomes compromised because of poor tissue feee, delayed ischemia, or an inadequate bite during the suturing.
Knots may be placed intraluminally or extraluminally at the preference of the surgeon. After the posterior anastomosis is complete, a ureteral stent is placed, and then the anterior anastomosis is completed. Tissue sealant is applied, and tissue wrap omental or peritoneal is used if readily available.
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A closedsuction drain is placed adjacent to the anastomosis. The nephrostomy tube is left in place and capped. English English Farsi.
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