—Gutierrez1 drew attention to the clinical indications for division of the renal isthmus in cases in which the diagnosis of horseshoe kidney has been made urographically. First are those in which there are no symptoms and in which the condition is discovered accidentally at operation; in these no surgical treatment is called for. Second are those in which horseshoe kidney is associated with urologic conditions, consisting of urinary symptoms of various kinds, with indefinite abdominal or lumbar pain and with reflex gastrointestinal disturbances, all chronic or recurring in acute attacks. These are the cases in which division of the renal isthmus is indicated for restoration of normal anatomic relationships, relief of pressure on important vessels and nerves and restoration of proper renal drainage. They constitute the great majority of clinical cases. Third are cases in which some kind of gross associated pathologic process is present in half
SCHOLL AJ, HINMAN F, VON LICHTENBERG A, et al. REVIEW OF UROLOGIC SURGERY. Arch Surg. 1943;46(3):422–457. doi:10.1001/archsurg.1943.01220090117010
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