NEW METHOD OF SKIAGRAPHIC DIAGNOSIS FOR RENAL AND URETERAL SURGERY

G. KOLISCHER
1901 Journal of the American Medical Association (JAMA)  
and others four years ago showed the necessity of skiagraphs in all suspected cases of renal stone. Our method, now to be described, will perfect the knowledge of the topography of the kidney and ureter, the location of calculi and aid in important differential diagnoses. A conservative and plastic surgery of kidneys and ureters has lately made such prog-Fig. 1.-Cadaver experiment. ress and achieved such good results\p=m-\werefer especially to Fenger and McArthur cases\p=m-\thatthe absence of
more » ... hatthe absence of such diagnostic measures was the stimulus for our work. To a limited extent the different methods of collecting urine from each kidney and the cystoscopic observation of the ureteral openings has satisfied this desire. Skiagraphs frequently show the kidney-shaped shadow of the kidney while the representation of the ureters on the plate naturally failed on account of the delicate structures of these tubes. highest value may be obtained and diagnostic problems solved that hitherto have been obscure! The technique is as follows: For locating the ureteral openings in the bladder and sounding the ureters in most of the cases we use Brenner's cystoscope; only in a few cases, where special peculiar conditions prevailed, we resorted to an improved modification of Casper's cystoscope. Extensive cadaver work convinced us that the most desirable material for the sounds is lead, blended with some antimony. This kind of lead-wire is extremely flexible, so that the natural course of ureters would not be changed by introducing the sound. These sounds are soft and their surface polished up to perfect smoothness, so that injuries to the lining of the renal pelvic Fig. 2.-Tangential insertion of ureter and dilated renal pelvis. and of the ureter are not to be expected, and, in fact, are not to be observed, as careful examination in cadavers has proven. If you free the ureter by dissection in a cadaver, its course is not changed by the introduction of our sounds, unless excessive force is used. On the other hand, this wire is sufficiently strong not to be torn by its movements through the canal of the cystoscope. Our results and the diagnostic possibilities of our methods can best be discussed on examination of the pictures which we present. We desire to say that we selected a number of cases as representative types of certain pathologic conditions. The first two pictures are taken from a cadaver and show that, although the sound was pushed up with all possible force, the course Downloaded From: http://jama.jamanetwork.com/ by a Carleton University User on 06/16/2015
doi:10.1001/jama.1901.62470450008001b fatcat:yfitt3b3v5cqlps2wak7t4bfq4