Step 5. UP anastomosis A.A. Kural

Anastomosis

• With a 4-0 Vicryl suture the posterior wall of the anastomosis is prepared and sutured. The suture is then continued in a running fashion to the lateral walls of the anastomosis.
• Anastomosis is finalized but not before placing correctly the JJ stent. In order to ensure that the guide wire is correctly inside the bladder occlusion of the folley from the start of the procedure is adviced.
• Retroperitonealization of the kidney after finishing anastomosis is strongly recommended with the use of a suture or Hem-o-lock clips. This step can be life-saving when urine leakage occurs.  

Special precautions

•  If a crossing vessel or a stone are present the best practice is to manage them concomitantly.
• Crossing vessel must be bypassed and the anastomosis must be made in front of it
• Stone(s) can be extracted with the use of flexible instrument and a basket catheter from the opening of the renal pelvis.