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A Note on the Localization of Renal Calculi by the Aid of X-Ray Films Made During Operation1
A NOTE ON THE LOCALIZATION OF RENAL CALCULI BY THE AID OF X-RAY FILMS MADE DURING OPERATION 1 WM. C. QUINBY From the Urological Clinic of the Peter Bent Brigham Hospital, Boston, Massachusetts
The important aid which the X-ray affords the surgeon in the immediate localization of renal stones at the operating table, needs no longer any emphasis. Its use has entirely superseded the older and cruder methods such as needling the kidney, or exploratory laparotomy. Granting this, the present remarks deal only with the matter of roentgenological procedure. The most direct and quickest exploration of the kidney is that made with the fluoroscope. By its use the observer can very accurately direct the surgeon to one or another portion of the kidney in which the stone lies. The fluoroscope, however, produces no graphic record of the kidney, and because of the apparatus involved as well as the need of eyes whose pupils have become well dilated by darkness, the surgeon cannot see the stone shadow for himself. He must depend on the word of the observer. A second method of acquiring X-ray evidence is that which I wish to advocate; namely, the exposure of the flexible films, wrapped in light tight paper, and held closely apposed to the kidney in much the same way as dental films are made. The film is then immediately developed and serves as graphic evidence of the number and position of calculi within the organ, as well as of their physical characteristics. Also, calcareous detritus, which if allowed to remain will serve as a nucleus for the formation of a second stone, can be accurately visualized and removed either by the blunt spoon or by washing. In some of the more complicated cases several films will be made, but 1 Read at the annual meeting of the American Association of Genito-Urinary Surgeons, Stockbridge, Mass., May, 1924.
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the final one should show the kidney free from all traces of shadow-casting material. . For purposes of record, too, it is exceedingly gratifying to be able to demonstrate a film of the kidney itself without any intervening structures, which will bear witness at any time subsequent to operation that the organ was in fact made by that operation entirely free from stones. This point is so important that we now make such a film at the end of each operation for renal stone, even though the aid of the X-ray was not necessary in order to locate the stone. In some instances of marked perirenal pathology often due to one or more previous operations, it has been impossible to exteriorize the kidney to a degree sufficient to permit satisfactory X-ray examination. Such cases are rare, however, for with a directly transverse incision it is possible to mobilize a kidney upward and toward the midline to a degree often impossible through the more oblique approach.
The important aid which the X-ray affords the surgeon in the immediate localization of renal stones at the operating table, needs no longer any emphasis. Its use has entirely superseded the older and cruder methods such as needling the kidney, or exploratory laparotomy. Granting this, the present remarks deal only with the matter of roentgenological procedure. The most direct and quickest exploration of the kidney is that made with the fluoroscope. By its use the observer can very accurately direct the surgeon to one or another portion of the kidney in which the stone lies. The fluoroscope, however, produces no graphic record of the kidney, and because of the apparatus involved as well as the need of eyes whose pupils have become well dilated by darkness, the surgeon cannot see the stone shadow for himself. He must depend on the word of the observer. A second method of acquiring X-ray evidence is that which I wish to advocate; namely, the exposure of the flexible films, wrapped in light tight paper, and held closely apposed to the kidney in much the same way as dental films are made. The film is then immediately developed and serves as graphic evidence of the number and position of calculi within the organ, as well as of their physical characteristics. Also, calcareous detritus, which if allowed to remain will serve as a nucleus for the formation of a second stone, can be accurately visualized and removed either by the blunt spoon or by washing. In some of the more complicated cases several films will be made, but 1 Read at the annual meeting of the American Association of Genito-Urinary Surgeons, Stockbridge, Mass., May, 1924.
59
60
WM. C. QUINBY
the final one should show the kidney free from all traces of shadow-casting material. . For purposes of record, too, it is exceedingly gratifying to be able to demonstrate a film of the kidney itself without any intervening structures, which will bear witness at any time subsequent to operation that the organ was in fact made by that operation entirely free from stones. This point is so important that we now make such a film at the end of each operation for renal stone, even though the aid of the X-ray was not necessary in order to locate the stone. In some instances of marked perirenal pathology often due to one or more previous operations, it has been impossible to exteriorize the kidney to a degree sufficient to permit satisfactory X-ray examination. Such cases are rare, however, for with a directly transverse incision it is possible to mobilize a kidney upward and toward the midline to a degree often impossible through the more oblique approach.