Subcutaneous pelvioureteral lumbar implantation, in lieu of ureterectomy after nephrectomy / by A. Ernest Gallant.

  • Gallant, A. Ernest.
Date:
1906
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Licence: In copyright

Credit: Subcutaneous pelvioureteral lumbar implantation, in lieu of ureterectomy after nephrectomy / by A. Ernest Gallant. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    April 24: Cystoscopy showed bladder normal, urine discharging from the left ureter, but owing to a defective lamp I was unable to pass a catheter into the ureter. April 30 : Very few streptococci and staphylococci found in urine, and no tubercle bacilli. May 1: Urine passed, 38 ounces ; May 2, 44 ounces. As the pain continued and the patient was losing ground, and the distention in the right loin continuing very great, it was decided to bring her to town, catheter- ize the ureters, and be guided by our findings. After considerable difficulty, Dr. W. Ayres succeeded in intro- ducing a catheter into the pelvis of the left ureter, with- drawing enough urine for examination. On the right side, however, the catheter could not be passed higher than four inches, nor could any urine be drained there- from. Diagnosis: Ureteral stricture in scar of former opera- tion. Dr. Louis Heitzman reported that the catheter specimen from |eft ureter showed pyelitis. Operation was done May 23, at 7.45 a. m. Pulse 92, temperature 99° F. Dr. Ayres assisted. Dr. Moss ad- ministered ether. An oblique incision, six inches long, was made through the skin and through the muscles and fascias by splitting with the fingers. On attempting to free the kidney, a peri nephritic abscess at its anterior and upper part was opened. The enlarged kidney (6x4x2$) pelvis, and ureter were very markedly dis- tended down to and below the pelvic brim. After freeing the kidney, its size was diminished by drawing off several ounces of purulent fluid, and the artery and veins ligated with black silk. After cutting the kidney free from the ureter, a probe was introduced down to a point apparently corresponding to that at which the catheter was blocked from below. The ureter was sutured into the lower angle of the lumbar wound, its mouth opening outside the lumbar fascia, into the subcutaneous fatty tissue. The muscles were sutured in three tiers, and a gauze drain carried down to the vascular stump. A small wick of gauze was inserted into the mouth of the ureter and brought out on the surface. The skin was partially closed with silkwormgut, and dressed with balsam oil. After a rather stormy first week the pulse and tem- perature subsided, the discharge diminished, and the general condition rapidly improved, so that on the tenth day she sat up in a chair for 45 minutes, and on June 7,