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Nephrectomy for Hydronephrosis



Dr. Deaverfurther reported the case of a man, thirty-eight years of age, who from early boyhood had suffered from par oxysmal attacks of pain in the right side, referred along the right ureter. During these attacks had a desire to urinate im mediately, the pain ceasing at the end of micturition. When sur rounding circumstances prevented micturition, he would strike his right side sharply ; this relieved the pain to some extent. These attacks would take place either several times a day, or at intervals of one or two months. The quantity of urine passed varied from one-half ounce to twenty ounces.

This condition continued until four years ago, when he no ticed a swelling in the right loin of about the size of an apple, accompanied by a sharp pain. In three or four days the tumor partially disappeared. Then for several years the tumor slowly increased in size until again• about the size when first noticed. One year ago he had an attack of jaundice lasting three or four months, and since this time the tumor has been growing rapidly until it occupies the right hypochondriac, the right lumbar, the right iliac, and the umbilical regions.

The urine was frequently examined and always pronounced normal. His appetite is always good ; he has not lost weight.

A blood examination showed haemoglobin, 65 per cent. ; red corpuscles, 4,500,000 ; leucocytes, 4,000,000 ; so it was practically normal blood. Believing the kidney to be in the condition of a hydronephrosis, an operation was done by the extraperitoneal route. This operation was particularly easy, from the fact that it was a large cystic organ. The cyst was exposed and aspirated ; that reduced it. There was one common cyst, consequently there was no trouble in evacuating, after which the remaining part of the operation was very simple. It was terminated by suturing the wound and anchoring the ureter, after tying the distal end. This patient has recovered without a bad symptom.

The specimen consists of a mass of tissue, kidney shaped, fifteen by six centimetres in size, which is attached to the walls of an apparent cyst. The walls of the cyst are about five milli metres thick and are in direct contact with the remains of the kidney proper.

The interior of the kidney is in direct communication with the cyst cavity and forms part of the side of the cyst. The in terior of the kidney has practically disappeared, and the stroma has changed so as to form several incomplete compartments, all in contact with main cyst cavity and opening into it.

The walls of the kidney proper are ten millimetres thick.

cyst, kidney, pain and size