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Calculus of the upper urinary tract

The American Journal of Surgery
Publication Date
DOI: 10.1016/0002-9610(30)90121-3
  • Medicine


Abstract 1. 1. We present data concerning 70 patients operated upon at Bellevue Hospital for calculus disease of the upper urinary tract; these represent 51 kidney operations and 22 ureteral operations. 2. 2. The vast majority of our patients come to the hospital for the relief of renal pain. 3. 3. Kidney and ureteral stones usually decrease the renal function, and increase any existing infection. 4. 4. Spinal anesthesia has been used with great satisfaction in the more recent operations. 5. 5. Pyelotomy is the operation of choice for kidney stones; a pyelonephrotomy or a nephrectomy may be necessary. 6. 6. Only the larger pyelotomy and ureterotomy incisions are sutured after the removal of the stone. 7. 7. Following the 51 operations for stones in the kidney, there were 8 deaths, most of which occurred in desperately ill patients with trouble of long standing and with symptoms demanding operative relief. There were no deaths following the 22 ureteral operations. 8. 8. A curved loin incision is used for kidney and upper ureter stones; the oblique Gibson incision for lower ureter stones. 9. 9. In cases of bilateral calculi, as a general rule operate first upon the stone, the removal of which will most markedly enhance the total renal function. 10. 10. Indications for operation are, diminishing function, increasing infection, anuria, ureteral stone over 1 cm. in diameter, persistent pain, and recurring hematuria. 11. 11. All ureteral stones should be ultimately removed by cystoscopic manipulations preferably, or by operation.

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