Kidney and Ureter

Abstract

Renal and ureteric surgical anatomies are presented for the general surgeon. A review of anatomy inclusive of the musculature, fascia, lymphatics, and vasculature are provided as background. As we considered development of the chapter, we thought the most instructive approach would be to review classic open incision techniques such as the lumbar/flank and the anterior abdominal, transperitoneal approaches. An understanding of the ability to access the kidney electively or in an urgent capacity will always require proficiency in one of the aforementioned methods. The most common procedure for a general surgeon to perform in the urinary tract is a nephrectomy, and therefore a step-by-step outline is provided.

The ureters are a ubiquitous organ in the abdomen and pelvis, often acting in a surreptitious manner much to the dismay of many surgeons. The anatomical review highlights the course of the ureter from the ureteropelvic junction into the true pelvis where it enters the bladder being one of the few organs to course within separate cavities. Finally, a description of open ureteral reconstruction via an end-to-end ureteroureterostomy is depicted incorporating well-known anastomotic techniques of the general surgeon.