Lumbotomy -

Proximal
Ureterolithotomy
Randa Halfian
 Definition
Lumbotomy : Surgical approach
to provide direct extraperitoneal
acces to the kidney and mid and
upper ureter
Manual of urologic surgery, Jackson E. Fowler. 2012

Proximal ureterolithtotomy :
Open surgery procedure
performed for the removal of
proximal ureteral stones
Hinmann Atlas of Urologic Surgery. 2012
 Anatomy

Transverse section through the kidney and posterior abdominal wall

showing the lumbodorsal fascia incised. Note that through such a
lumbodorsal incision the kidney can be reached without incising
muscle. (After Kelly and Burnam, from McVay C: Anson & McVay
 Anatomy

Anatomy of ureter, physiologic narrowing of ureter,

radiographic ureteral segmentation and ureteral blood supply
( Campbell-Walsh Urology, 9ed)
 Indication
Lumbotomy :
all procedure Nephrolithotomy
to access Pyelolithotomy- extended
kidney and pyelolithotomy
proximal Bivalve nephrolithotomy
ureter by Pyeloplasty
extraperiton Nephrectomy-partial
eal approach nephrectomy
by open Ureterolithotomy proximal
surgery such
as
(Manual of urologic surgery, Jackson E. Fowler. 2012
Indication for active removal ureteral
stone
Stones with low
likelihood of
spontaneous
passage;
persistent pain
despite adequate
pain medication;

persistent
obstruction;

renal insufficiency
(renal failure,
bilateral obstruction,
single kidney).
(EAU guideline, 2013)
 Indication

Alternative choice for active ureteral stone removal (EAU guideline, 2013)
 Indication for open surgery in
ureteral stone

Large impacted stones

Multiple ureteral stones

In cases of concurrent conditions requiring surgery

When other non-invasive or low-invasive procedures have

failed

If indicated, for upper ureteral calculi, ureterolithomy has

the highest stone free rate compared to URS and SWL

(EAU guideline, 2013)

 contraindiations

patients who are

medically unfit for
an open surgery or
who harbor an
active infection
Medscape references
 Preparation

Surgical cap, mask, sterile Sterile gauze, povidone iodin

gawn, sterile hand gloves 10%

Disinfection clamp, doek clamp

 Preparation

Electronic cauter
Surgical blade no 23, 11, scalpel
handle

Langenbac Kocher
k Suction
Sharp spreader
Ring clamp
 Preparation

Pean/mosquito
clamp Scissors Spreader
Pinset
DJ stent

Stone forceps
Nelaton Needle holder
catheter Right angle
 Preparation
NGT

Foley
cath +
urobag

Redon Drain

Yarn + surgical
 Procedure

Patient in
Placement the Insert urethral Lumbotomy
general
KUB picture catheter position
anastesia

(Hinmann Atlas of Urologic Surgery

(Hinmann Atlas of Urologic Surgery
Procedure

(Hinmann Atlas of Urologic Surgery

Procedure

(Hinmann Atlas of Urologic Surgery

 Procedure

Distal and proximal sondage

DJ stent placement if necessary

Routine stenting after uncomplicated
ureterolithotomy (complete stone removal)
is no longer necessary
Stents should be inserted in patients who
are at increased risk of complications (e.g.
residual fragments, bleeding, perforation,
urinary tract infections or pregnancy), and in
all doubtful cases, to avoid stressful
(EAU guideline, 2013)
emergencies
 Procedure

Closure the wound

Muscle and fascia with
polyglactin 1-0 continous or
Put redon drain interrupted
Sub cutan fat with plain cat-
gut 3-0 interrupted
Skin with polypropylen 3-0
interupted

(Hinmann Atlas of Urologic Surgery)

 Complication
injured peritoneal cavity and
During intra abdominal organ (2%);
operation Bleeding (2-6%), axillary
nerve palsy (1%)

Early Wound infection (10-15%);

urosepsis (10%); haematuria
postoperati (9-15%); leakage of urine-
ve urinoma (1-5%)

Late post fistule (5%), ureteral stricture

operative (15-20%)

(Hinmans atlas of urologic surgery)

Post operative care
KUB post
operatively
Remove urethral
catheter 1 or 2
day post
operatively
Remove drain if
production is
minimal
Release the
stitches 10-14
days
postoperatively
Thank you