In dealing with renal calculi in instances in which the previous examination has shown that the kidney is good enough to be saved, we need to have a variety of methods at our disposal in order to treat all patients satisfactorily and successfully. No one method will do, but we must vary our procedure according as the kidney is fixed or movable and according as we have a solitary stone to deal with, free in the pelvis of the kidney, or as the stone is branched and projects into the calices. Again, if the patient is very stout, and we have a long twelfth rib, we may be compelled to modify our technic.
A nephrolithotomy carefully done is a very safe procedure; if it is clumsily done, it may easily cost the life of the patient. On account of the risks from hemorrhage, there is a strong tendency to turn