Reconstructive surgery about the renal pelvis in the past has been assumed to call for the use of splinting catheters and nephrostomy tubes. Recent experience has convinced the authors that better results are obtained without these aids provided certain principles are followed. The kidney should be completely mobilized and the ureteropelvic juncture exposed for inspection. Nephropexy is done to elevate the kidney and hold the ureter in a straight line. The continuity of the pelvic and ureteral wall should be preserved, for transection is followed by weeks of dysfunction. Excessive stitching is avoided, and no attempt is made to obtain a water-tight closure. Rubber drains extending down to the renal pelvis are left in the abdomen for at least nine days. Eleven patients treated surgically in this way were able to leave the hospital on or before the 14th day in every case. One patient with a long history of lithiasis had recurrences that finally necessitated nephrectomy. The others showed steady improvement after operation with respect to both the function and the appearance of the renal pelvis.
Hamm FC. RECONSTRUCTIVE SURGERY FOR HYDRONEPHROSIS. JAMA. 1958;166(9):1023-1026. doi:10.1001/jama.1958.02990090031007