(1) Incision: from 12 costal apex or slightly below to the upper medial side of the anterior superior iliac spine.

(2) Cut off the muscle layer: cut off the external oblique muscle, internal oblique muscle and transverse abdominis muscle. When cutting transverse abdominis muscle, attention should be paid to avoid damaging the subcostal nerve, blood vessels, iliohypogastric nerve and ilioinguinal nerve.

(3) Exposing the upper ureter (Figure 1): After entering the retroperitoneal space, it can be seen that the ureter is located in front of the psoas major, and the spermatic artery and vein (or ovarian artery and vein) pass through the ureter, so the ureter should be protected to avoid injury. Expose the intermediate ureter:

Incision (1): Starting from two fingers above the midpoint of the iliac crest, along the transverse stripes of the lateral abdominal oblique muscle to the semilunar line of the outer edge of the rectus abdominis.

(2) Myotomy: Incise the external oblique muscle, internal oblique muscle and transverse abdominis muscle, and enter the retroperitoneal space.

(3) Exposing the middle ureter (Figure 2): The contents of peritoneum and abdominal cavity are pulled inward, where the ureter is often pulled with peritoneal mucosa, which is easy to be pulled with peritoneum but difficult to find. The blood vessels in the spermatic cord (or ovary) cross the iliac artery and vein at the lateral lower side of the ureter. Expose the lower ureter:

(1) Incision: Start from the inner side of the anterior superior iliac spine about 2cm, make an arc incision down to the ventral line, and reach 1cm above the pubic symphysis.

(2) Cut off the muscular layer: cut off the external oblique muscle along the muscle line, cut off the internal oblique muscle and transverse abdominis muscle, then cut off the syntendinous tendon transversely, and cut off the anterior sheath of rectus abdominis muscle if necessary. After muscle incision, the inferior epigastric artery and vein can be seen in the lower corner of the incision (Figure 3), so injury should be avoided. If necessary, it can also be ligated and cut off to facilitate the operation.

(3) Expose the lower ureter (Figure 4): In the lower ureter, women have uterine arteries and veins, while men have vas deferens and internal spermatic veins, which should be protected when separated.

Puncture the 3-0 gut line with a small curved needle, and intermittently suture the ureter with 2-3 needles (outline). Suture can only pass through the outer layer and muscle layer, not through the mucosa, so as to avoid recurrence of stones. Take out the protective gauze pad around the incision, cover the ureter suture with surrounding adipose tissue, and fix the adipose tissue with 1 ~ 2 needle.

If the inflammation of ureteral calculi is serious, it is necessary to make a small incision at the upper end of the ureteral incision, and insert the No.4 ~ No.5 ureteral catheter into the renal pelvis as drainage, and lead it out from the original abdominal incision or another small incision. After checking that there is no bleeding and foreign body residue in the wound, put the cigarette next to the ureteral incision for drainage. Lay the operating table flat and sew the muscles, subcutaneous tissue and skin layer by layer.