Operative surgery, for students and practitioners . f the kidney the renal vessels may becometwisted and the ureter acutely kinked, the flow of urine obstructedand a condition of hydronephrosis with accompanying pain, etc., pro-duced. The indication for nephropexy will depend upon the degreeof discomfort, etc., that the loose kidney causes. The patient lies prone upon the table with an Edebohls rubbercushion under the abdomen. A sandbag placed imder the upper part 656 URINARY SYSTEM. of the chest will materially relieve the embarrassment of respiration?which occurs in this position. The incisi
Operative surgery, for students and practitioners . f the kidney the renal vessels may becometwisted and the ureter acutely kinked, the flow of urine obstructedand a condition of hydronephrosis with accompanying pain, etc., pro-duced. The indication for nephropexy will depend upon the degreeof discomfort, etc., that the loose kidney causes. The patient lies prone upon the table with an Edebohls rubbercushion under the abdomen. A sandbag placed imder the upper part 656 URINARY SYSTEM. of the chest will materially relieve the embarrassment of respiration?which occurs in this position. The incision corresponds to the outer border of the erectorspinas muscle, commencing, above, at the twelfth rib, about two anda half inches from the middle line. It passes downward, curvingsomewhat outward, and terminates just above the crest of the incision should extend through the skin and subcutaneous fatdown to the surface of the aponeurosis of the latissimus dorsi incision is then carried through the aponeurosis, when the outer. Fig. 299.—Lumbar Incision for Exposing the Kidney. , erector spinas;, ilio-hypogastric nerve; , edges of the aponeurosis of the latissimusdorsi; , quadratus lumhorum; , twelfth dorsal nerve. horder of the erector spinse muscle is recognized. This muscle isdrawn toward the middle line with a blunt tractor. The quadratuslumborum, covered by its proper layer of the lumbar fascia, is,thenexposed in the bottom of the incision. The fascia that covers thequadratus lumborum is incised along the edge of the erector quadratus extends a little beyond the edge of the erector outer edge of the quadratus is thus exposed and this muscle islikewise drawn inward, toward the middle line, with the tractor. Theilio-hypogastric nerve appears at the outer edge of the quadratus lum-horum, about the middle of the incision and the twelfth dorsal nerve OPERATIONS UPON THE KIDNEY. 657 at the outer edge of the muscle i
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