Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York 2013.
Reconstruction of the collecting system
Tumors abutting or invading the collecting system may require direct collecting system entry. Retrograde filling with methylene blue through an open-ended ureteral catheter or intravenous administration of indigo carmine if the kidney is perfused aids in identification and repair. Closure of the collecting system can be accomplished by closure in layers using 2-0 Vicryl or a 3-0 unidirectional barbed suture with a Lapra-Ty (Ethicon Endo-Surgery, Cincinnati, OH, USA) at the end. Other techniques of collecting system closure have been explored. Bylund et al. employed a fibrin glue absorbable gelatin sponge sutured in place with no formal reconstruction of the collecting system in 104 patients. Two patients experienced a urine leak that was treated with conservative management.