404 DISEASES OF THE KIDNEYS 



of hydronephrosis, nephrolithotomy should be performed. 

 There are two methods used in this operation, as follows: 



(a) A longitudinal incision is made at the convex border 

 of the kidney, at which point the vascularity is at a minimum, 

 into the pelvis. In case hemorrhage is severe, clamping the 

 renal artery will control it. By compressing the kidney 

 longitudinally the incision will be held open and with a 

 blunt curette the stones are removed. Care should be taken 

 to be sure that the renal pelvis is freed of all the calculi, 

 and a blunt probe of small caliber inserted into the ureter to 

 be certain of a free passage into the bladder. Normal salt 

 solution, which has been previously sterilized, is used to 

 cleanse the cut surface. The wound is then stitched with 

 sterile silk, using two or three interrupted sutures. Care 

 must be taken not to use too much force in drawing the wound 

 together as the resulting swelling will tear out the sutures. 

 Return the organ to its proper position. Healing should take 

 place per primam. 



(b) The other method is to open the pelvis of the kidney 

 direct. Make an incision at one side of the pelvis, in about 

 its middle portion, of sufficient size to remove the calculi. 

 After all the stones have been removed and all the fluids 

 absorbed by sterile gauze, the wound is stitched carefully, 

 using plenty of sutures so that the edges of the wound will 

 be thoroughly approximated. This must be done carefully 

 to avoid fistula following the operation. If, however, ■ the 

 kidney is found diseased (hydronephrosis) nephrectomy 

 should be performed, as follows: Laparotomy is performed; 

 The kidney is then freed of its covering, gently pulled toward 

 the wound, and doubly ligated at its pedicle, so as to prevent 

 serious hemorrhage. Care should be taken to get the ligature 

 securely in place to prevent its slipping off after the abdom- 

 inal wound is closed. Double ligation is safest, ligating the 

 vein and artery separately. 



After-treatment consists in the administration of general 

 stimulants, and restricting the diet for four or five days to 

 milk, or milk and eggs. 



