DILATATION OF THE PELVIS OF THE KIDNEY. 55 



m the urethra or bladder, but, in such cases, the affection being bilat- 

 eral, the dilatation of the renal pelvis can never become so great as to 

 close the mouths of papillae of the kidneys without involving danger 

 to life. It seems strange that, on autopsy, hydronephrosis of both 

 sides, which seems to have existed a long time, is frequently found. 



ANATOMICAL APPEAKANCES. According to Rokitansky^ in the 

 milder degrees of hydronephrosis, the papillae are shrunken, hardened, 

 and leathery. Gradually the papillae disappear in the concavity of the 

 dilated calyx, while above it the renal substance diminishes, its tissues 

 becoming compressed, leather-like, and tough. In extreme cases, the 

 substance of the kidney is only a line or two in thickness, finally dis- 

 appearing, leaving a membranous sac, of a lobulated appearance exter- 

 nally, and cellular within. The cells communicate with each other, 

 their walls having burst or atrophied ; they contain a urinous liquid, 

 clear and serous, or turbid and containing a sediment, varying greatly 

 in character. These sacs may attain the size of a child's head, or even 

 that of a man's. A dilated ureter may attain almost any conceivable 

 size, its calibre equalling or even exceeding that of the small intestine. 

 The walls of the ureter are thickened, and the tube itself, instead of 

 running straight to the bladder, is tortuous and convoluted, like a gut. 



SYMPTOMS AND COTJESE. Hydronephrosis cannot be detected, ex- 

 cept in its most intense form, and, of course, this cannot exist when 

 both ureters are obstructed. The secretion of urine is not diminished, 

 as the active kidney acts vicariously for the disabled one. There may 

 not be any pain in the lumbar region. Diagnosis is solely based upon 

 the discovery of a somewhat soft and ^distinctly-fluctuating tumor in 

 the region of the kidney. If there be any temporary abatement of 

 the obstruction to the escape of urine from the organ, the tumor may 

 diminish from time to time, and such an occurrence sometimes aids the 

 diagnosis. When the sac becomes inflamed (as has sometimes been 

 observed), there is much pain, accompanied by severe rigors. The pus 

 which forms may point in various directions, thus giving great diversity 

 to the character of the symptoms. Should the impediment which has 

 obstructed one ureter extend so as to prevent the flow of urine into 

 the bladder from both kidneys, all secretion of urine will cease, and 

 the patient will speedily perish, under symptoms of uraemia. 



TREATMENT. If the obstruction lie in the urethra only, diligent 

 catheterization may prevent dilatation of the urinary passages, or arrest 

 such dilatation when it has commenced. It is out of our power, how- 

 ever, to arrest or to allay the graver forms of dilatation with atrophy 

 of the renal substance, which proceed from obstruction of a ureter 

 unless the obstruction of the ureter be caused by a tumor, susceptible 

 of relief by medical or surgical interference. 

 54 



