SUMMARY The ultrastructure of the narrow segment of the obstructive megaureter has been studied. The muscle cells are normal in appearance, their connections with each other are present in normal form and number and they receive a normal autonomic innervation. As in normal ureter no ganglion cells have been found. A great increase in the amount of collagen fibres in the submucosa and the muscle coat has been demonstrated which it is suggested is responsible for the poor drainage of the ureter and its consequent dilatation. This lesion is similar to that demonstrated in the narrow pelvi‐uretenc segment of idiopathic hydronephrosis. The ætiology in either situation is obscure.
SUMMARY The ultrastructural arrangement of the smooth muscle cells of the ureteric wall in man has been studied and contacts between individual cells have been demonstrated. The relevance of these muscle cell contacts to ureteric peristalsis has been discussed. The unmyelinated nerve fibres within the wall of the ureter in man have been studied. Nerve endings on the vascular musculature and the ureteric musculature have been described, which it has been suggested are efferent in function. Nerve endings in the submucosa have been described and their possible function suggested. No ganglion cells have been identified.
PARAPELVIC renal cysts occasionally cause deformity of the pyelocalyceal system of the kidney. It is very unusual, however, for such a cyst to produce marked obstruction of a part of the calyceal system without impeding the drainage from the rest of the kidney. Two such cases have been seen and been treated recently at St Peter's Hospital. One patient presented with symptoms referable to the affected kidney and the other was discovered to have a renal cyst during routine investigation of symptoms due to bladder outlet obstruction. CASE HISTORIESCase 1.-A. M., a 38-year-old bank manager, was referred for investigation of a single episode of a painless, total hiematuria. He had also noticed an intermittent aching pain in the left loin for several years. Over the 6 months prior to the episode of hiematuria this pain had been more obtrusive and was present almost every day. Some years previously he had been treated by his general practitioner for mild hypertension, but had received no drugs for a year before the hLematuria occurred.On examination he was a fit, slightly overweight man with a blood pressure of 160/120 mm. Hg. There was no other abnormality in his cardiovascular system and general examination was unremarkable. Neither kidney was palpable. FIG. 1 FIG. 2 Fig. 2.-Case 1 : Renal scan.Fig. 1.-Case 1 : Left kidney on excretion pyelogram.Investigations.-An excretion pyelogram showed a normal right kidney, but on the left side the kidney had a bifid pelvis with obstruction of the upper calyces and slight distortion of the lower caIyces by a space-occupying lesion (Fig. 1). A renal scan using Hg197 Chlormerodrin showed a suspicious area in the centre of the left kidney (Fig. 2). Aortography and selective left renal arteriography were performed. This showed the biiid left renal pelvis with a moderate degree of hydronephrosis in the upper half of the kidney (Fig. 3). The blood supply to this portion of the kidney was rather scanty and there was some evidence of cortical filling with a pressure deformity on the upper calyx in the lower part of the kidney. There was no tumour circulation and a diagnosis of simple renal cyst was made.Treatment.71.e left kidney was explored through a left loin incision. A large parapelvic cyst was exposed. The drainage system from the upper group of calyces was found to be compressed between the cyst and the main 398
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