(4) A soft splinting catheter is usually left in place until healing has taken
The wound is closed in layers and dressed in the routine manner.
e. Operative Procedure for Ureterolithotomy.
(1) The patient usually has a kidney, ureter, and bladder X-ray examination
immediately before surgery to determine the exact location of the stone. The surgeon
may also schedule a cystoscopic examination preoperatively and may attempt to
manipulate the stone through the ureter.
(2) The position of the stone determines the surgical approach. A stone
high in the ureter will require a flank incision, whereas one closer to the bladder will
require an abdominal incision. Both of these have been described previously. The
incision into the ureter is made with a small surgical blade above the stone. The
Randall stone forceps will be used to locate and remove the stone. The ureter may be
closed with fine chromic gut sutures number 4-0, or it may be left open and the site
drained well. Either approach requires minimal routine closure.
(3) Ureterocutaneous transplant, ureterosigmoid anastomosis, and ileal
segment are all urinary diversion procedures performed when the bladder no longer
serves as a proper urine reservoir. The cause may be a congenital disorder (as in the
neurogenic bladder), exstroptiy, trauma, or tumor.
f. Operative Procedure for Ureterocutaneous Transplant (Anastomosis).
The surgical approach is the same as for a low ureterolithotomy, and the ureter is
severed from the bladder. The severed ureter is passed through a stab wound in the
flank and sewn to the skin with an everting suture-of number 4-0 chromic gut on an
Atraumatic needle to form a stoma. The structures are handled with plastic instruments,
fixation forceps, and iris scissors. A small catheter is passed into the ureter and
irrigated for patency. The patient must have a urine collecting bag postoperatively.
g. Operative Procedure for Ureterosigmoid Anastomosis.
(1) The abdomen and peritoneal cavity are entered in the routine manner
through a left rectus incision. A portion of the large bowel is protected with pads. Deep
retractors are placed, and with long forceps and scissors the posterior peritoneum is
(2) The ureters are severed close to the bladder. The ureter is brought
through the posterior peritoneal incision to the sigmoid. Traction sutures and smooth
tissue forceps are used to retain and handle the severed ureters.
(3) The sigmoid colon is immobilized to prevent traction and tension on the
ureter by securing the former to the pelvic peritoneum at a point where the ureter falls