. On the origin and progress of renal surgery, with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter . n so made,the incision should preferably radiate from the hilum : butwhen the parenchyma is very thin, and a large branchedcalculus or several calculi are present, the incision may bemade in any direction which gives the greatest facility—for—extracting the stones. In calculous pyonephrosis I have removed seven stonesthrough as many separate incisions in the thin pa
. On the origin and progress of renal surgery, with special reference to stone in the kidney and ureter and to the surgical treatment of calculous anuria. Together with a critical examination of subparietal injuries of the ureter . n so made,the incision should preferably radiate from the hilum : butwhen the parenchyma is very thin, and a large branchedcalculus or several calculi are present, the incision may bemade in any direction which gives the greatest facility—for—extracting the stones. In calculous pyonephrosis I have removed seven stonesthrough as many separate incisions in the thin paren-chyma. After the removal of the calculus, the rest of thekidney can be explored through this incision ; or, if not, asecond incision should be made in the convex border ofthe organ. OPERATIONS ON TEE KIDNEY AND URETER. 123 As long ago as 1829 Gerdy* had advised that the convexborder of the kidney should be selected for incision innephrotomy. The advantages, depending on the anatomicalarrangement of the blood-vessels within the kidney, of anincision along this border are considerable. Moreover, throughno other single incision can a complete examination of thecavity and substance of the kidney be so conveniently Fig. 27.—Kidney with uric-acid calculus impacted in its Museum, No. 828.) (Westminster It is the opinion of Barthf and Turner that the extent ofparenchymal degeneration about nephrotomy wounds dependschiefly on the size of the vessels divided ; and if this be so, itis a further reason for making the incision, as Gerdy advised,along the convex margin. After removing a calculus from the renal pelvis, if theconvex border has not been incised, the interior of thekidney should be palpated either through the opening, or, * Gerdy, P. 1ST. : Anatomie des Formes Exterieures du Corps Humain (Paris, 1829). See note on page 153. t Arehiv f. klin. Chir., Von Langenbeck, 1893, xlvi., 418. 124 HUNTEIIIAN LECTURES. if this be too small to admit the finger
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