stone intact or to explore a calyx where a small stone or fragment has slipped. The
presence of a staghorn calculus is an indication for this procedure.
b. Operative Procedure.
(1) For opening. The kidney is approached as described for nephrectomy,
using the desired incision. The renal pedicle is identified; the ureter is identified and
retracted as necessary. The kidney is mobilized to permit approach to the aspect
(2) For pyelotomy or pyelostomy. The pelvis of the kidney is incised with a
small blade. Traction sutures of number 3-0 black silk on French eye or swaged-on
needles may be placed at the edges of the incision to hold it open while the pelvis and
calyces are explored. In pyelostomy, the catheter is placed through the incision directly
into the renal pelvis.
(3) For nephrostomy. A curved clamp or stone forceps is passed through a
pyelostomy incision into the renal pelvis and then out through the substance of the renal
paren-chyma via a lower pole minor calyx. The tip of a Malecot or Pezzer catheter is
then drawn into the renal pelvis, and the pyelotomy incision is closed. The distal end of
the tube is brought out through the flank incision. Penrose drains are placed, and the
incision is closed in the regular manner.
(4) For pyelolithotomy. The renal pelvis is opened, and the ureter may be
probed for stones or strictures by passing a ureteral catheter and irrigating. Stones are
removed. A multieyed catheter-- Pezzer, Malecot, or Foley type--is placed. The
catheter is secured with sutures. A purse-string suture may be placed around the
nephrostomy tube. After removal of a staghorn calculus, mattress sutures are usually
tied over a pad of renal fat to support the long parenchymal incision.
(5) For closure. An incision in the renal pelvis may be closed with fine
chromic-gut swaged on needles or left unclosed. The wound is drained and closed, as
for nephrectomy. Reinforced absorbent dressings or special wound decompression
apparatus is required for draining wounds.
a. General. This operation involves the removal of a kidney and the entire
ureter that drains it. It is indicated for the presence of hydronephrosis, a hydroureter too
damaged to repair, or carcinoma of the renal pelvis or ureter. This procedure usually
requires two separate incisions, one in the flank and one in abdomen. Two separate
instrument sets are not required, but a second skin preparation setup and set of sterile
drapes are required.