Ureterolithotomy, Pyelolithotomy and Nephrolithotomy
Objective
In case of:
• Stones in the upper urinary tract
• Removal of calculi from
a. Ureter
b. Renal pelvis
c. Kidney.
Position
• Lateral (upper ureter)
• Supine (lower ureter, kidney).
Anesthesia
General.
Procedure
1. Flank incision is made with rib resection (twelfth) optional.
2. For stones within the renal parenchyma (nephrolithotomy).
3. Temporary interruption of the renal circulation.
4. Parenchyma incised and the calculus removed.
5. Fatty tissues may be used to bolster the suture line.
6. Stones in the renal pelvis (pyelolithotomy) or in the proximal ureter (ureterolithotomy).
7. Extracted through incisions overlying the stones.
8. Collecting system is irrigated and sutured closed.
9. Calculi in the distal ureters are approached retroperitoneally.
10. Inguinal, lower midline abdominal, or transverse oblique incision.
11. The stone is palpated, noting that the ureter proximal to it may be dilated.
12. Control of the ureter proximal and distal to the stone is achieved with vessel loops or atraumatic clamps.
13. The ureter is opened and the stone retrieved.
14. Irrigation may be employed and the ureter is closed.
Instruments
• General set
• Deep instruments set
• Kidney set
• Thoracotomy tray, vascular procedures tray, and gastrointestinal procedures tray (available)
• Hemoclip appliers (assorted sizes and lengths)
• Asepto syringe
• Vessel loops and umbilical tapes
• Dissectors (e.g. peanut)
• Penrose drain 1" (retraction)
• Gil-Vernets sinus hooks (Fig. 11.16).
Any questions be sent to drmmkapur@gmail.com
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