Urology / / May 07, 2016
(method of operation)
Depending on the location of the stone different approaches used in the ureter.
position of the patient. When localization stone in the upper and middle third of the ureter of the patient is placed in the position as in kidney surgery, with the presence of stone in the lower third of the ureter - the horizontal position on the back.
Tools include a set of forceps to extract stones, rubber taped to mobilize the ureter.
course of operations. To remove the stone from the upper and middle third of the ureter produces the cut by Fedorov.Only if there is a stone in the middle third of the cut start from about the middle of the XII rib and lead toward the scallops ilium.The usual way reveal the retroperitoneal space.Reveal the retroperitoneal and pre-renal fascia.Peritoneum medially upward push.Determine the ureter.It is usually covered predmochetochnikovoy fascia and beneath it appeared through a thin network of venous plexus.When pressed on the tip of the
To access the lower third of the ureter and ureter yukstavezikalnoy use the following method: the incision begins at the crest of the ilium, is carried out parallel to the inguinal crease, and then directed to the midline of the abdomen parallel to the pubic bone (turns klyushkoobrazny section).Cutting the skin, subcutaneous tissue, dissect the fascia of the abdominal muscles (external oblique, the internal oblique and transverse) and penetrate the preperitoneal fat.Identification point for finding the ureter is a place of division of the common iliac artery to the internal and external iliac.In this place it is located behind the peritoneum ureter.He is recognized by his relation to the described vessels, visible peristalsis and venous plexus located on the front wall.Peel off the soft tissue of the ureter with a blunt clamp curved or blunt needle Deschamps, held back the ureter.Under the ureter is fed a thin rubber strip and the ureter tighten up some.Determine the location of stone, and then my sister takes catgut №2 on the needle.On either side of the intended cut in the ureter applied provisionally taped two of catgut №0 and between a pointed scalpel over a stone cut wall of the ureter.The stone is removed with forceps.Sister takes the ureteral catheter.Once the stone is removed, check the patency of the ureter above and below the location of stone ureteral catheter.Convinced of ureteral patency, to impose a section of the wall 2-3 №0-2 catgut suture in the adventitia.To place the incision is supplied drainage tube.The wound was sutured in layers.