Metastatic Staphylococcal Prostatic Abscesses

Abstract

On the left side the shadow showed dilatation of the pelvis and calices, and dilatation of the ureter along its entire length.On October 29th, 1930, a specimen of the fluid passed per rectum was examined. It was brownish in colour with a slight admixture of faeces. The specific gravity was 1010, the reaction alkaline, and there was a trace of albumen. On centrifugalising, no pus cells could be detected.To complete the examination of this boy, he was sigmoidoscoped after the injection of indigocarmine deeply into the buttock. The mucous membrane of the bowel looked normal in every respect. The instrument could not be passed far enough to see the orifices of the ureters. Urine, comparatively free from admixture with faxes, flowed into the instrument, and was collected for examination. A tube was placed in the rectum and the blue colour of indigocarmine was not apparent in the fluid collected till after the lapse of one and a half hours. This fluid contained 1 per cent. of urea.Intravenous pyelography in this patient clearly shows that the structure and function of the right kidney are seriously damaged, and that a destructive process is also taking place on the left side. The blood urea, which was 27 mgm. per 100 C.C. before the second operation, isnow 51. The absence of pus is against infection of the kidneys. It is obvious, however, that there is back pressure on both sides. The unfortunate occurrence of temporary blocking after both operations may be in part to blame, but I am inclined to think that some degree of hydronephrosis is likely to occur after this operation of transplantation of the ureters. I n future operations an attempt might perhaps be made to obviate this by embedding the terminal portions of the ureters more loosely in the wall of the pelvic colon.Owing to the rise in blood urea and the results of intravenous pyelography, it was considered advisable to postpone indefinitely operation on the bladder and penis-especially as the patient himself and his parents are well satisfied with his present condition.