Anterior transperitoneal approach for treatment of urolithiasis.

An anterior transperitoneal incision was used to remove stones from 20 kidneys in 18 patients (2 bilateral). Our experience with 35 kidneys operated upon by this method (15 previously reported) has been favorable. Use of percutaneous nephropyelostomy tubes to drain obstructed kidneys in septic patients has permitted all procedures to be done under non-emergency conditions. Careful alignment of x-ray equipment and adjustment of exposure technique in the operating room before induction of anesthesia result in consistently good quality preoperative and intraoperative roentgenograms. The transperitoneal approach has afforded good access to the anterior portion of the renal pelvis even in those patients who have had previous operations on the kidney by the flank approach. Additional intra-abdominal procedures done at the same operation have included urinary diversion by ileal loop, revision of previous ileal loop, ureterolithotomy, pyeloureteroplasty, partial nephrectomy, cholecystectomy and appendectomy. The procedures done with the patients in the supine position have been well tolerated even in patients with serious coincident medical diseases.