Surgical considerations in nephrolithiasis

ABSTRACT

For the successful removal of kidney stones, the kidney and upper ureter should be correctly exposed by the proper lumbar extraperitoneal incision. The size and location of the stone, as well as the perirenal pathology and anatomic variations of the kidney, influence the methods of surgical removal. An incision through the renal pelvis is much to be preferred to that through the cortex for anatomic and functional reasons, but it has been found possible in only about 25 of patients herein reported (exclusive of those nephrectomized). The closure of pyelotomy is easily performed, that of a nephrotomy just as easily but with subsequent diminution of renal function due to constriction of endarteries. Accessory extrarenal obstructive factors must be attended to. Resection of the lower pole to remove a dependent stone-bearing lower calyx is a logical step in the prevention of recurrences. Badly damaged kidneys will have to be completely removed in unilateral cases. (Summary)