1928 DISEASES OF THE URINARY ORGANS 



changes. Lesions may also be found from the pelvis of the kidney 

 to the meatus urinarius, but are most common in the bladder. 



Morbid Anatomy. — The earliest changes are found in the bladder 

 in the formation of a general infiltration and thickening of the 

 mucosa with bilharzial tissue. Over this thickened mucosa is a 

 layer of adherent mucus, which is apparently protective. In this 

 mucus numerous eggs are found. Later hypersemic patches are 

 found associated with vesicles, which are especially marked around 

 the trigone, and contain a whitish fluid in which there are eggs. 

 The hyperaemic patches increase in size and thickness, and the whole 

 bladder becomes much thickened. Papillomata of all shapes and 



Fig. 778c. — Bladder showing Lesions of Bilharziosis. 



sizes are formed principally on the trigone and the posterior wall 

 of the bladder. These papillomata bleed readily, giving rise to the 

 haematuria. 



As the eggs increase in amount, connective tissue forms round 

 them, and they die and become calcified, thus giving riseto brownish- 

 yellow, sandy patches,^ not protected by mucus, and leading to an 

 atrophy of the mucosa of the viscus. 



The urine collects in the hollows between the papillomata, and, 

 decomposing, gives rise to phosphates, which produce a whitish 

 incrustation on the bladder wall. The orifices of the ureters may 

 become obstructed, giving rise to backward pressure, causing hyper- 

 trophy of the ureters and hydronephrosis. Septic infection is very 

 liable to spread from the bladder up the dilated ureters to the 

 kidney. Bilharzial tissue may also form in the ureters and the 

 pelvis of the kidney, and take the form of infiltrations and papil- 



