Microsoft Word - UIN385BF

Conventional stone operations have decisively receded into the background due to modern methods of stone removal, e.g., extracorporeal shock-wave lithotripsy and endoscopic stone removal. The disadvantages of these modern methods are discussed. Because there are no complications by the conventional technics, which are still practised, the technical details are also discussed. Prof. D. Hauri, Urologische Universitätsklinik, Frauenklinikstrasse 10, CH-8091 Zürich (Switzerland) Extracorporeal shock-wave lithotripsy, percutaneous litholapaxy and ureterorenoscopic stone removal are elegant and attractive methods, which have doubtlessly enriched modern stone surgery. For the patients they mean less stress and a shortened convalescence. For this reason we must not conceal their disadvantages. The considerable physical stress of the X-rays, which to date are unavoidable in modern procedures, is indisputable. Additionally it is a fact that open surgical operations have a clearly shorter operation and anesthesia time than the two endoscopic procedures. At least, the present trend results in the situation that fewer and fewer good urologists will be qualified to perform open stone operations. For example, some authors prefer ureterendos-copic stone removal to ureterolithotomy because the latter is said to show a complication rate of 10% and more. In this case the technical inability of the surgically active urologist must be taken into account. In the following the operative concepts are not detailed; for that purpose there are enough textbooks available. We confine ourselves to a key word-like description of some well-tried operation principles. Surgery of the Ureters It is recommendable to expose the ureter extraperi-toneally to guarantee an uncomplicated postoperative process. As we know from the anatomy, the ureter vessels are supplied by arteries which run along the adven-titia and divide intramurally. From this follows – as an old surgical principle – that the ureter should be exposed carefully, without trauma and outside the adventitia. Hard forceps and nonelastic bridles produce the typical presuppositions for postoperative necroses and fistulas. To avoid the involuntary ‘back-floating’ of the stone into the renal pelvis in case of wide ureters, the stone must be located carefully and the ureter immediately bridled proximally. Unnecessary surgical trauma and expansion of the surgical access can thus be saved, which is very important for the postoperative phase. Removal of the stone by proper incision and careful detachment (e.g. by a fine-bellied bougie) avoids local necroses and postoperative fistulas. The ureter is washed out proximally and distally to prove whether any other concrements exist. Temporary endogenous drainage of the ureter is advanD ow nl oa de d by : 54 .7 0. 40 .1 1 10 /6 /2 01 7 1: 48 :3 0 A M