LESSON 3: Procedures in Genitourinary Surgery

Section Iii: operations on the kidney, ureter, and adrenal glands

3-13

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Section III. OPERATIONS ON THE KIDNEY, URETER, AND ADRENAL GLANDS

3-13. GENERAL CONSIDERATIONS

a. Stones, infections, and tumors are the most common causes of urinary tract obstruction necessitating operations to prevent renal destruction or failure. Obstruction may also be due to malformations of the urinary tract.

b. Although the causes of kidney stones are obscure, certain conditions such as obstruction, stasis, or body chemistry predispose to their formation. Stones may form from various elements: calcium oxalate, calcium phosphate, magnesium ammonium phosphate, uric acid, and calcium carbonate, or combinations of these substances may be found. All stones removed at operation are usually subjected to chemical analysis. Stones obtained as surgical specimens are best submitted in a dry jar. Fixative agents such as Formalin^R can obscure the results of the analysis.

c. Stones in the renal pelvis may drop down into the opening of the ureter (the uretero-pelvic junction) and occlude it, or they may pass into the ureter and lodge at the ureterovesical junction or where the ureter passes into the bony pelvis at the level of the iliac crest. A stone may lodge in a renal calyx and continue to enlarge, eventually filling the entire calyx or renal pelvis (staghorn stone).

d. Hydroureter, hydronephrosis, and fibrosis with destruction of the renal parenchyma can result from unrelieved obstruction.

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