17,1 Eduque: Relief of Poliakiuria 81 
ureter, injected a solution of collargol through the catheter, and 
had the patient X-rayed. See Plates 5 and 6. 
The skiagraph shows that the solution of collargol was found 
only at the upper third of the ureter, the middle and lower 
thirds being completely devoid of any of the solution. To my 
mind, this absence of the solution of collargol from the lower 
parts meant that the site of pathological stenosis was along the 
whole extent of the middle and lower ureter, diminishing its 
lumen, and by periuretheral adhesions binding these portions 
of the ureter toward the middle line of the body, thus deviating 
these parts of the ureter from their normal situation and course. 
With this diagnosis in mind, the operation was advised, which 
was willingly acceded to by the patient so long as, in her words, 
she would be no longer bothered by michthiuria. 
The technic of the operation was as follows: A left lateral 
incision across the abdomen was made beginning from a point 
2 to 3 centimeters below the lowermost part of the left costal 
arch and corresponding to the.external border of the left rectus 
abdominis muscle, downward toward the anterosuperior iliac 
spine to a point about 2 to 3 finger-breadths from it, and then 
curving inward and slightly downward toward the median line 
of the abdomen and distant about 3 to 4 finger-breadths from the 
iliac spine. The incision was deepened, cutting through the 
oblique muscles. A hzemorrhage, produced by severing the epi- 
gastric vessels, was controlled by clamp and ligature; then the 
fascia transversalis was carefully cut and separated from the 
parietal peritoneum, to avoid opening or injuring the peritoneal 
serosa. The peritoneum of the posterior abdominal wall was 
carefully rolled in with the fingers toward the median line of 
the abdomen, starting from the external iliac fossa, and when 
the external iliac artery was exposed this vessel was used as 
a guide in looking for the bifurcation of the primitive iliac at 
which level, on account of its hard feeling, the ureter previously 
catheterized was easily found. A portion of the ureter was 
localized in this way, and was traced upward and downward 
to appraise its course, and it was found to be surrounded by 
adhesions binding it toward the central side of the body. After 
carefully loosening up these adhesions along the extent of the 
middle and lower thirds of the ureter, I was finally able to lift 
up these portions of the duct and to bring them up through 
the wound. When the loosening up of the adhesions was com- 
pleted and the ureter permitted to remain in its normal position, 
after removing the catheter, the closure of the wound was ac- 
174675——-6 
