An American text-book of genito-urinary diseases, syphilis and diseases of the skin . f the twelfth rib and the sacro-lumbar muscle, down to thecrest of the ilium, and then parallel to it, along it, and then down alongPouparts ligament to the upper orifice of the inguinal canal. Cut off thekidney, ligate the ureter, pull it out, and enucleate progressively from abovedown to the bladder. This is an exceptional operation to be employed incases of obliterations of the ureter only, and, as permanent fistula? are infre-quent, it will be rarely indicated. H. A. Kelly details the operation of nephro-
An American text-book of genito-urinary diseases, syphilis and diseases of the skin . f the twelfth rib and the sacro-lumbar muscle, down to thecrest of the ilium, and then parallel to it, along it, and then down alongPouparts ligament to the upper orifice of the inguinal canal. Cut off thekidney, ligate the ureter, pull it out, and enucleate progressively from abovedown to the bladder. This is an exceptional operation to be employed incases of obliterations of the ureter only, and, as permanent fistula? are infre-quent, it will be rarely indicated. H. A. Kelly details the operation of nephro-ureterectomy as follows (seeFigs. 186, 187, 188): Oblique lumbar incision from the sacro-lumbar portionof the erector spinae downward and forward 2 cm. anterior to the anterior supe-rior spine of the ilium, and then obliquely downward to the terminal of thesemilunar line 2 cm. above the symphysis pubis. The perirenal fat is loosenedfrom the kidney, and the latter brought out of the incision, drawing it downover the lower lip of the incision to expose the renal vessels, pelvis, and. Fig. 186.—Extra-peritoneal nephro-ureterectomy Cadaver with kidney detached and entire ureterseparated down to its vesical extremity through the incision shown in the cut, without opening the peri-toneum at any point (Kelly). ureter. The kidney and pelvis are now examined to determine whethernephrectomy or a conservative operation is to be done. When tuberculosisis found nephrectomy is done. The vessels are clamped by artery-forceps1 cm. from the kidney, after freeing them from the surrounding fat. Thevessels are then ligated separately if possible. If the ureter is found to be diseased, the kidney and entire ureter are nowremoved in the following manner: By pulling on the kidney and ureter thelatter is made tense and dissected out from the surrounding loose connectivetissue, with the index and middle fingers pushing the colon and cecum toone side and stripping off the loose connective tissue surro
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Keywords: ., bookcentury1800, bookdecade1890, booksubject, booksubjectsyphilis
