Ureter

“ The pressure of urine soon puts a stop to further secretion, and there is no time for a slow and gradual dilatation of the pelvis and ureter. When, as is much more frequently the case in the human subject, the obstruction is more gradual or incomplete, the back pressure is for a long time insufficient to completely stop the passage of fluid through the renal capillaries, so that the pelvis and ureter, though allowing their contents to pass out only under a considerable vis-a-tergo, have time to accommodate themselves to the change, and dilate gradually, attaining sometimes enormous dimensions. ”

“ Rupture of the ureter is a very rare injury. Poland has collected the histories of four cases, one of which ended in recovery after the evacuation by puncture, at intervals, of about two gallons of fluid resembling urine. The other cases terminated in death during the first, fourth, and tenth weeks respectively. Peritonitis was apparently not present in any of the cases, the urinary extravasation having occurred into the cellular tissue behind the peritoneum. ”

“ The male bladder offers greater difficulties, which are at present insurmountable. A point opposite the lower end of the ureter can, it is true, be reached with some difficulty in the rectum, and it is possible that a catheter might be so adjusted as to make counter-pressure to the finger in this position, but there could be no certainty that the occlusion was complete. ”

“ The kidneys extend along the whole length of the body-cavity; and the ureter, which does not reach the whole length of the kidneys, is a thin-walled wide duct lying on the outer side. On laying it open the numerous apertures of the tubules for the kidney are exposed. The Müllerian duct, which opens in both sexes into the abdominal cavity, ends, according to Leydig, in the cases of some males, blindly behind without opening into the ureter, and Müller makes the same statement for both sexes. ”

“ Symptoms. When the deposits are in the kidneys, there is pain in the back and loins, occasionally cutting and severe; sometimes it darts down the course of the ureter to the bladder, and extends even to the thighs. When the deposits are in the bladder, there is a frequent desire to urinate, with a bearing-down, straining pain; also a cutting or scratching sensation in the urethra during micturition. In the male, intense pain is often experienced at the end of the penis. ”

“ Thus, vesical tumours pressing on the orifices of the ureters, calculi which have become fixed in them, torsion or “kinking” of the ureters, may bring about hydro-nephrosis. The urine secreted by the kidney being unable to escape, accumulates in the pelvis of the kidney, in the ureter, and uriniferous tubules, producing dull colic, which escapes observation, or the exact cause of which is not discovered, because the second kidney vicariously acts for the one affected, and urination continues regularly. ”

“ An abundant flow of urine might perhaps carry off more rapidly such individuals as have found their way into the urinary passages, and, considering the character of the deposit described above as causing stoppage of the ureter, treatment directed against the uric-acid diathesis might diminish the risk of this particular form of trouble. ”

“ The hinder part of the kidney is the predominant renal organ. There is a common uro-genital duct, into which a seminal vesicle, which is especially large in early spring, opens. This is the permanent condition of the frog. In the rabbit, for urogenital duct, we have ureter and vas deferens; the testes and that anterior part of the primitive kidney, the epididymis, shift back into the scrotal sacs, and the ureters shift round the rectum and establish a direct connection with the bladder, carrying the genital ducts looped over them. ”

“ It is important to remember that every ureteral fistula does not require an operation. It is always advisable, when it has been clearly established that a woman has a leaking ureter, to wait a little, certainly six weeks, for many fistulæ of this kind will gradually close. In describing such a case, Jonas draws attention to a cystoscopic sign of some value. He performed a total hysterectomy for fibroids, and on the tenth day the nurse reported the escape of urine by the vagina. The daily output of urine from the bladder, which had averaged 50 ounces, fell to 25 ounces. ”

“ The ureter or duct of the kidney begins at the hilum and descends on the back wall of the abdominal cavity to open into the bladder. It is usually about 12 in. in length and as thick as a goose quill. At its termination it passes obliquely through the coats of the bladder, so that when the bladder is distended:sewn the lumen of its end is closed. The urinary bladder is a membranous bag lying in the pelvic cavity directly behind and above the dorsal surface of the pubes. In the foetus and infant, however, the bladder lies in the abdomen, not in the pelvis. ”

“ On the other hand some observers (Kupffer, Bornhaupt, Braun) maintain, in [Pg 723] accordance with the account given above, that the outgrowths of the ureter form only the collecting tubes, and that the secreting tubuli, etc. are formed in situ in the adjacent mesoblast. ”

“ In the male the hand detects the condition of the organs contained within the pelvic cavity, the fulness or emptiness of the bladder, or the existence of calculi within it. More deeply seated can be felt the entire length of the right 503ureter; its state of dilatation can be felt, and the existence of diverticula of inflammation, if any, can be ascertained. The left ureter cannot readily be examined, on account of the position of the rectum, except as regards the posterior part, close to the bladder and the rumen. ”

“ From the right kidney, 14 cc. of urine, containing 2.4% urea, and a slight amount of pus; from the left kidney 3⁄4 cc. of urine, a very little urea and a large amount of pus. A nephrectomy of the left kidney a few days later revealed a small tubercular pyonephrotic kidney, with an apparently normal ureter.
In April, 1910, this patient was heard from directly for the last time. By virtue of his social status he was forced to lead a life which was not in conformity with his personal welfare, doing hard manual labor most of the time. ”

“ There is a case described of a man who evidently suffered from a patent urachus, as the urine passed in jets as if controlled by a sphincter from his umbilicus. Littre mentions a patent urachus in a boy of eighteen. Congenital dilatation of the ureters is occasionally seen in the new-born. Shattuck describes a male fetus showing reptilian characters in the sexual ducts. There was ectopia vesicae and prolapse of the intestine at the umbilicus; the right kidney was elongated; the right vas deferens opened into the ureter. ”

“ The diagnosis of eversion of the bladder presents no difficulty. The everted mass appears to have a narrow neck opposite the meatus, and is seen to form a reddish, unctuous mass. The mucous membrane now forms the external coat and appears covered with mucus so long as inflammation does not occur.
The urine continually escapes from the ureters (which open on the surface of the mucous membrane) as it is formed, and flows away by the lower commissure of the vulva. The vulva is half open, and the prominence formed by the bladder projects beyond it. ”

“ The part of the ureter itcpated in the hilum is dilated, and is named the pelvis of the 1 ney. In minute structure the kidney is the most complex gland in the body. Each of the papillae consists of a large number of straight tubes—collecting tubules-which open by pores on its surface. When these are traced into the pyramid, they are seen to divide several times, their line end-branches projecting in little tufts into the cortical matter at the base of each pyramid. ”

“ The urinary apparatus (consisting of the kidneys, ureters, bladder, and urethra) is known to be the principal emunctory for eliminating and voiding the detritus formed by the continual decay of the parts comprising the animal economy. The urine is this detritus in a state of solution. The components of urine are chemically similar to those of calculi, and as the components of the one vary according to the disintegration occurring at the time in the vital alembic, so do those of the other. ”

“ When this has been made quite clear, then, before the animal urinates, one has to tie a ligature round his penis and then to squeeze the bladder all over; still nothing goes back through the ureters to the kidneys. Here, then, it becomes obvious that not only in a dead animal, but in one which is still living, the ureters are prevented from receiving back the urine from the bladder. These observations having been made, one now loosens the ligature from the animal’s penis and allows him to urinate, then again ligatures one of the ureters and leaves the other to discharge into the bladder. ”

“ Stricture of the urethra, prostatic disease, and gravel, or stone in the bladder, are all capable of producing obstruction to the free flow of the urine.
How Slight Ailments become Dangerous Diseases. As we have before stated, the mucous membrane lining the bladder is reflected upwards into the ureters, lining these canals. By reason of this continuity of mucous surfaces, patients suffering from urethral, prostatic, and bladder affections, often die from disease of the kidneys. ”

“ This collection takes place in the kidney, the ureters (the vessels that convey the urine to the bladder) , the bladder, and sometimes in the urethra. The stone so formed varies in its composition and size, and is one of the saddest ills that can befall human nature. Hence the importance of watching, and attending to every urinary disturbance, of which gravel forms a prominent feature, the treatment of which has been already stated; but which, as it involves more practised judgment than a non-professional invalid can be supposed to possess, had better be intrusted only to professional hands. ”

“ Erections and seminal emissions in men follow pressure on the pubic veins and prostatic portion of the urethra. Retention of urine also may come from the latter cause. If the kidneys and ureters are compressed by fecal tumors in the descending or transverse [p. 647] colon, nephritic pain, albuminuria, or retraction of the testicle, with delay in the escape of urine, may happen. Icterus and its consequences are owing to pressure on the common bile-duct; the liver and other organs may be displaced and the aortic circulation obstructed by fecal compression. ”

“ The kidneys then are big filter-glands. They, like the lungs, are made up of a mesh, or network, of thousands of tiny tubes of two kinds, one set of tubes being blood vessels, and the other set the tiny branches of the kidney tubes which finally run together to form the ureters. The urine filters through from the spongy mesh of blood tubes (capillaries) into the kidney tubes and is poured out through the ureters. It is very important that the urine should be discharged as fast as it fills the bladder, that is, about once every three hours during the day. ”

“ They are fasten'd to the Midriff, Loins, and Aorta, by the Emulgent Arteries; as also to the Bladder by the Ureters. The Right Kidney likewise adheres to the Gut Cæcum, and the Left to the Colon. Their Office is to filtrate or strain the Urine in the Pelves or Basons, which they have in the middle of their Body on the inside, and to cause it to run thro' the Vessels call'd Ureters into the Bladder.
Immediately above the Reins on each side, is a flat and soft Glandule, of the thickness of a Nut ”

“ In severe cases, most excruciating pain is experienced during the discharge of the contents of the bladder. The urine is often bloody; in general it is of a milky appearance, containing lymph or puriform matter, and vitiated secretion from the lining membrane. Micturition is almost constant, small quantities being voided at a time. Sometimes the inflammation extends to the ureters and pelves of the kidneys, causing violent pains in the loins, nausea, occasional vomiting, and colicky affections. ”

“ This is accomplished in the larger animals with the oiled hand in the rectum, the nails having been pared short and even to avoid injury to the mucosa. In ponies and yearlings the kidney may be felt, and this may be true also of mature animals of larger species in cases of hypertrophy or floating kidney. The ureters, bladder and intrapelvic urethra are easily felt in the male. The empty bladder lies on the anterior border of the pelvis; when full, it projects forward into the abdomen but retains its pyriform or, in the very young animal, its fusiform shape. ”

“ The animal’s hind legs being secured, the operator smears his hand and forearm with some fatty substance, and, forming the fingers into a cone, introduces them with gentle pressure through the anus, the palm of the hand being turned downwards. Passing the hand gently along the rectum, the operator will be able to distinguish the conical posterior pouches of the rumen, the loop of the duodenum, the mass of convolutions of the small intestines and of the colon, etc. Next, he will examine the vagina, uterus, bladder, ureters, kidneys, aorta, and the pelvic and sublumbar lymphatic glands. ”

“ The sensations or sensitive motions of the glans penis, and of the sphincter of the bladder, have been accustomed to exist together during the discharge of the urine; and hence the two ends of the urethra sympathize by association. When there is a stone at the neck of the bladder, which is not so large or rough as to inflame the part, the sphincter of the bladder becomes stimulated into pain ”