UHETEIUC CALCULUS. 237

It is sometimes possible to dilate the vesical orifice of the
ureter or even cut it with a ureterotome in the female, so that
a stone impacted at the entrance of the bladder can be passed
into the bladder and captured with a lithotrite.
Certain practical points must be observed in dealing with
any stone in the ureter. Whenever possible the stone should
be pressed up into a more healthy portion of the ureter so
that the incision shall be made through healthy tissues and
into a tube of larger calibre. The incision is longitudinal
and is best united with fine catgut, but in doubtful cases
healing will occur if the ureter be simply dropped back into
the wound and a drainage-tube passed down to it. Before
the ureter is stitched up a bougie should be passed both up
and down to see if the rest of the ureter is clear of stone and
stricture.
If the uHne is aseptic there is no need to explore the
kidney if it is known to be free from stones, and the ureter
will heal without stricture or fistula.
If the urine is infected the problem is more complicated.
