226 Surgical Diseases and Surgery of the Dog 



planted in different parts of the bladder, in the vagina, in the skin, 

 and in the intestine. In one instance, Tizzoni and Poggi made an 

 artificial bladder out of a knuckle of small intestine in which they 

 implanted both ureters, the animal completely recovering. 



Anastomosis or Uretero-ureterostomy was successfully accom- 

 plished in 1887 by Poggi, who invaginated the upper segment into 

 the lower and sutured it in position. Since then, van Hook, Bovee, 

 and Kelly have experimented in the same direction and the technic 

 of their several methods differs only in minor respects. 



This operation is only available when the severed ends can 

 be easily approximated. The ureter of the dog runs in a com- 

 paratively straight line from the kidney to the bladder, and if more 

 than half to one inch of its continuity is destroyed, the tension 

 to which it is subjected by stretching is too great to permit of re- 

 union being maintained. But Bovee has shown that this difficulty 

 may be overcome by taking advantage of the mobility of the kidney 

 and displacing it posteriorly. The gland may be separated from its 

 surrounding tissues and brought down to the level of the iliac crest 

 and there stitched to the abdominal wall. This procedure gives 

 considerable slack to the ureter. 



Implantation in the bladder or Uretero-cystotomy may be 

 undertaken with good results, though there is always considerable 

 risk from cicatricial stenosis with resultant hydronephrosis. 



Implantation in the bowel or Uretero-enterostomy is not a 

 practicable operation for the reason that intestinal bacteria invari- 

 ably ascend the ducts and give rise to pyelonephritis. It was at 

 first believed that if the trigonum vesicae were implanted together 

 with the ureteral orifices the ascending infection might not take 

 place, but the experiments in this direction all terminated fatally 

 through sloughing of the implanted part. The reason of this was 

 made apparent in the discovery that the blood-supply of the tri- 

 gonum came from the vesical arteries, and not from the ureteral, 

 so that in order to preserve the nutrition of the parts implanted 

 it would be necessary to include a large part of the bladder wall 

 which operation would practically resolve itself into Cysto-enteros- 

 tomy or Vesico-rectal anastomosis, which is described elsewhere. 

 Peters claims that if the ureters be so implanted that their free 

 ends project into the lumen of the bowel, a natural valve is there- 

 by produced, simulating the bile papilla, and that by this means 



