The Relation of the Ureteral Catheters to the Surgery of the Kidneys in Women
Boston Medical and Surgical Journal
On looking over my clinical records I find that during the last three years I have catheterized the ureters for supposed surgical disease of the kidneys seventeen times, all tho patients being women. I do not intend to inflict upon you the history of the seventeen cases, nor even of all the operative cases. I propose, instead, to limit myself to a statement of the conclusions which my experience has led me to adopt, and to explain those conclusions by brief outline reports of the salient
... the salient features of a few of the cases which best illustrate my positions. Of the various methods of ureteral exploration of tho kidneys in women, the study of the separated urines of the two kidneys takes the chief place, and furnishes ua with a method of physical examination of the kidneys which is bo far accurate and safe that the ureteral catheters occupy to the surgery of the kidneys in women much the same relation which the stethoscope has so long'held to the medical diseases of the chest. The importance of this examination rests upon the fact that it enables us to isolate the diaeaae and to determine with certainty not only which kidney ia affected, but exactly what the condition of each kidney is. The points which I think especially worth illustrating are : (1) Tho symptoms may be transposed, that is, the pain and tenderness may be referred by the patient to the comparatively sound kidney. (2) There may be a transitory inflammatory affection of the sound kidney which should lead us to defer operation until it has passed away. (3) The choice between nephrotomy and nephrectomy, and sometimes the decision as to whether any operation is or is not permissible, should be decided by a comparison of the relative condition of the two kidneys. (4) In cases of renal calculus, the question between neplirolithotomy and nephrectomy must depend largely upon whether the condition of the affected kidney affords a prospect of good healing and a useful kidney after nephrotomy. Case I. Mrs. II., seen October 13, 1896, with Dr. Hayes, of Willianisburg, Mass. Much emaciated and very weak. Has had frequent micturition and foul urine ever since an acute febrile attack twenty years ago. Passed two small stones, a few weeks apart, six years ago. Had a sharp hemorrhage from the bladder nine months ago. Is conscious at intervals of sharp pains undorneath the right false ribs. There ia tenderness on palpation over the right renal region ; and on vaginal examination the vesical end of the right ureter is decidedly thickened and very sensitive. A provisional diagnosis of stone in the right kidney seemed clear.