Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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e hydronephrosis is often gross, thekidney destroyed and functionless, and the infant stillborn. B. Acquired Causes. Strictures of the urethra, enlargement of theprostate, and pelvic tumours (notably cancer of the uterus), cause bilateralhydronephrosis. Causes of unilateral hydronephrosis are foreign bodiesimpacted in the ureter, such as stones, clots, parasites; stenosis of theureter following ulceration ; pressure on the outside of the ureter by tumours,pelvic cellulitis. &c. The ureter is narrowed by the manner of its develop- HYDRONEPHROSIS 5:!5 ment at its junction with the kidney and bladder, and an excess of thisnatural narrowing easily leads to stenosis. Moreover, in the developmentof this tube, spiral folds and twists are present which should be smoothedout, but should they persist, lead to stenosis. The rotation, which thekidney undergoes as it passes up to the loin, accounts for some kinks of theureter, while the occasional abnormal renal artery which grows out from the
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Fig. 184. I, Bilateral hydronephrosis, from a congenital valve of the urethra.(Authors case.) II, Unilateral hydronephrosis, from impaction of a stone in the ureter. aorta and passes behind the ureter will strain across the latter, particularlywhen the kidney is mobile, and cause obstruction (Fig. 175 a, p. 511). Pathology. The pelvis and ureter above the obstruction dilate, later,the kidney tissues become thinned, and a cyst results, filled with a fluidof low specific gravity containing traces of urea, some salts, and oftenalbumen. The inside of the cyst is smooth, unlike that of a pyonephrosis,which is lined with granulation tissue. The cyst, as it dilates, pushesother organs aside, but does not become adherent, and microscopically tinparenchyma Is at! opine and replaced by fibrous tissue. When both kidneys are affected the patient gradually succumbs touraemia; when the condition is unilateral the opposite kidney hyper-trophies to Compensate the loSS, bul the degenerated kidney seem

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