Pyelo-ureteritis cystica

Abstract

THE first recorded description of pyelo-ureteritis cystica was that of Morgagni (1761), who reported his post-mortem findings on a patient who had suffered from chronic urinary obstruction. In I929 the condition was first diagnosed radiologically by Joelsen, but since then the number of reported cases has been small. McNulty (1957) CASE REPORTThe patient was a married woman aged 60 years who complained of recurrent attacks of pain in the left loin of 4 years' duration. The attacks were fairly severe in nature and were associated with nausea, shivering, and sometimes vomiting. She had suffered from increased frequency of micturition during attacks but had no dysuria and no hzmaturia. Initially, the attacks occurred at intervals of 3-4 months and lasted for some 2 days, but more recently she had experienced trouble every 4-6 weeks and lasting for some 2 weeks.ON EXAMINATION.-The patient was a rather pale woman of average build. There was no evidence of recent weight-loss. Abdominal examination showed her to be tender in the left loin and an indefinite cystic mass was palpable in this site. The blood-pressure was I90/90 mm. Hg. No other abnormality was noted on clinical examination. The haemoglobin was 90 per cent; blood-urea 34 mg. per cent; and E.S.R. 15 mm. in the first hour (Wintrobe).Intravenous pyelogram: This showed that in the right kidney function was normal and no abnormality was noted.No function was present in the left kidney. showing the cysts within the renal pelvis and at the pelvi-ureteric junction.Cystoscopy and retrograde pyelography : The bladder capacity was 400 ml. The base and trigone were moderately injected, but otherwise the bladder was normal. Both ureters were catheterized to 20 cm. without difficulty. Urine specimens were collected from the bladder and the right ureter. No urine was obtained from the left ureter. The bladder urine showed a heavy deposit of pus cells, and culture yielded a profuse growth of Bact. coli, highly sensitive to nitrofurantoin, chloramphenicol, streptomycin, and tetracycline, but only relatively poorly to sulphafurazole. There were no pus cells in the specimen from the right ureter and the culture from this side was sterile. In the retrograde film (Fig. 805) the right kidney and ureter were normal, but the left kidney appeared to be hydronephrotic and the left ureter was studded with numerous radiolucent shadows.AT OPERATION (Dec. 8, 1959).-The left kidney was exposed through a lumbar incision. The kidney and renal pelvis were grossly dilated and the renal parenchyma reduced to a thin shell. There was no hydro-ureter and though the ureter felt a little irregularly thickened it was not macroscopically abnormal. The kidney and proximal two-thirds of the ureter were removed.