4.the incision will be done in lateral side or abdomen to reach ureter after reaching an oblique incison will be done directly above stone place to avoid injury of ureter
The answer of the interactive Questions : Q1: The direction of the ideal incidion in the ureter for surgical removal of a stone is a small incision, most commonly in the back, creating a narrow tunnel directly to the kidney to break up and remove large or irregularly shaped stones. -And if it is by ureteroscopy (as in removal of the stone fragments), the the surgeon inserts a narrow, flexible instrument called a ureteroscope through the urethral opening, passing it through the bladder to where the stone is located in the ureter or kidney. Q2 : the stone in the ureter gives referred pain to the tip of the clitoris or penis because in its lower 1/3, there is suprapubic pain associated with frequency as the ureter is related to the ilioinguinal and genitofemoral nerves.
The pain is felt at the tip of the penis or clitoris usually when the stone is lodged low in the ureter and this is because that the afferent fibers supplying this part travels through L1 & L2 segments to which afferent fibers of the genitofemoral nerve also travel.. P.s: the pain may be also referred along the femoral branch so the pain is experienced in the front of the thigh..
Stones frequently become stuck in this part of the ureter. If so, they can cause urinary symptoms, including frequency (the need to urinate more frequently than usual), urgency (the need to urinate as soon as the urge to go is felt), and postvoid fullness (the sense of the need to urinate further even after one has urinated). These symptoms mimic the symptoms of urinary tract infection. Patients may think they have a bladder infection, but most often these voiding symptoms are due to the stone. When stones are in the lower part of the ureter, they may also cause pain that is referred to the testicle or the tip of the penis in men or into the vaginal and urethral area in women. this what I found
1. The position of the longitudinal incision made on the lateral side of the ureter to avoid cutting off its medial arterial supply. 2. Because the cutaneous regions of these are supplied by the same spinal segments, the pain is transmitted to the tip of the clitoris or penis.
Q: 2. The referred pain of stone Becauce the same nerve that supply the ureter, supply the loin( T10 ), groin and inguinal (T12,L1),and scrotum and labia magora(L1)
Distal ureteral stones cause pain that tends to radiate into the groin or testicle in the male or labia majora in the female because the pain is referred from the ilioinguinal or genitofemoral nerves.
on the lateral side to avoid cutting any blood vessels and the incision is longitudinally because they have the same lymphatic drainage مش متاكدة الصراحة
2 - The muscles in the wall of the ureter try to squeeze the stone along into the bladder , This causes burning sensation during urination and pain may move down to the tip of penis
