HYDRONEPHROSIS 189 



tumors, or abscesses of the prostate, paralysis of the bladder, as in spinal 

 paralysis, or in hydronephrosis. 



Pyelitis occurs in a number of forms varying according to the intensity 

 of the irritation and is generally part of other morbid processes. This 

 disease is recognized by means of the microscope, particularly when we 

 discover epithelium of the pelvis of the kidney in the urine, or by manual 

 examination of the kidneys through the abdominal wall, when enlarge- 

 ment of the pelvis ma}' be detected (see also parasites of the kidney) , or 

 there may also be present some symptoms of inflammation of the kidney 

 or catarrh of the bladder. The treatment consists in the attempt to 

 remove the original irritant. 



Hydronephrosis; Dilatation of the Pelvis of the Kidney. 



Etiology and Pathological Anatomy. — Whenever there is a stenosis or 

 stricture of the urinary passages and consequent obstruction, the urine 

 is dammed back and presses on all the canals behind the point of obstruc- 

 tion, and as a consequence the canals are distended and finally become 

 enlarged. If the obstruction is in the urinary tube, the bladder, ureters, 

 and the pelvis of the kidney become enlarged; but if one ureter only is 

 afTected, the corresponding kidney becomes enlarged; and where the pelvis 

 is much distended and after the condition has lasted some time, the body 

 of the kidney becomes absorbed. The whole kidney becomes converted 

 into a pouch-like mass of connective tissue, filled with liquid. This fluid 

 at first is urine, but soon becomes converted into mucous secretion. In 

 one case described by Siedamgrotsky, he observed, instead of a kidney, a 

 large bladder or cyst, with walls formed of connective tissue, filled with a 

 syrupy brownish fluid containing numerous cholesterin crystals. This 

 condition is produced gradually, for any sudden interference or stoppage 

 of the flow of urine would produce ursemia or rupture of the urethra and 

 uraemia and death in a short time, but in hydronephrosis the condition 

 comes on slowly and may result from periodic irritation and stricture of 

 the urethra, from tumors of the prostate, the presence of calculi in the 

 canals, or b}^ inflammation of the mucous membrane of the bladder. 



Clinical Symptoms and Therapeutics. — The cystic kidney in slight 

 cases is rarely recognized; in more acute cases it is indicated by a fluctuat- 

 ing painless tumor in the region of the kidney; in certain cases there is a de- 

 cided enlargement in the size of the abdomen; by puncture and use of an 

 exploring trocar we find the fluid described by Siedamgrotszky, "When 

 there is double hydronephrosis the urine is suppressed and symptoms of 

 uraemia are shown very quickly. The disease can only be treated success- 

 fully when it is caused by obstruction of the urethra; for instance, where 

 the obstruction is due to a calculus in the urethra and it is removed by 

 surgical means. 



