PATHOLOGY OF THE BLADDER AND URETER. 385 



Benckiser records two cases. In the first the lower ureteric 

 opening was originally outside and below the urethral orifice. 

 After two operations by ligature by Sanger, a fistula formed in 

 the upper third of the vagina and to the right side. Implanta- 

 tion into the bladder was refused. 



Benckiser's second case is interesting, as the lower opening of 

 the ureter was immediately below the urethral orifice. This 

 was sounded with difficulty, until by temporary closure of the 

 orifice the tube became dilated. The ureteric sound could then 

 be passed to the level of the linea innominata. The kidney was 

 somewhat deep, and on cystoscopic examination two ureteric 

 orifices were found in the bladder. Benckiser believes there 

 was thus a third ureter, but this does not quite follow. On 

 operation he removed the lowest part of the abnormal ureter, 

 and thus turned the lower aperture of the remaining part into the 

 bladder. Microscopically the portion removed was found to be 

 ureter in structure. 



I postpone consideration of Benckiser's explanations of his 

 cases to a subsequent part of this paper. 



The last paper is by Olshausen, who records two cases. In 

 the first, a girl, ten years old, the abnormal opening was to 

 the right of the hymen. The right ureteric opening was not 

 present in the bladder. In the second case, a girl of fifteen, the 

 lower opening lay to the right and a little below the urethral 

 orifice. After several attempts the patient was cured by turn- 

 ing the ureter into the bladder. 



The excised portions were found structurally to be ureter. 



Benckiser states tliat Schwarz had collected 25 cases of 

 abnormal opening of the ureter, and 23 where the ureter ended 

 blindly. 



Olshausen draws attention to valuable papers by Tangl and 

 Seycheron. 



Tangl's case is interesting, as the left ureter and WolfQau 

 duct ended blindly, close to one another, in the anterior vaginal 

 wall. Seycheron's paper gives a very full resumt^ of cases of 

 ureteric anomalies, and discusses the causes fully. 



In the typical case of apparent abnormal low opening of the 

 ureter, the orifice is near the urethral orifice or hymen edge : 

 in one case (von Massari) it was on the left edge of the 



