Clarence G. Bandler

Vesical neck obstruction with large vesical calculus. Bilateral hydroureters with hydronephrosis. Double left kidney and ureter

to the Urological service of the New York Post Graduate HospitaI in July, 1928. The patient’s compIaint was painful micturition, which symptom had been constant for a period of 5 years. This pain was continuous throughout the act, and was particularly severe at the termination of the flow. No urethral discharge nor hematuria had been observed, but the stream was markedly diminished both in size and force. The patient voided about four times during the day, and there was frequency of four or five times at night. what emaciated, of rather saIIow compIexion and very anxious mien, who evidentIy had Iost considerabIe weight. Eye examination is negative. Nose and throat revea1 an atrophic rhinitis on the right side, with muco-pus in smaI1 amounts exuding from Ieft turbinate bone. UvuIa was markedIy eIongated and reddened, whiIe the tonsiIs were deepIy imbedded and congested, and a moderate amount of puruIent materia1 was expressed therefrom. The pharynx was congested, and the epipharynx was dry with crust formation. Diagnosis of subacute tonsiIIitis and pharyngitis was made from the aforesaid findings, and IocaI treatments were immediateIy instituted. Heart and Iungs were essentiahy negative. AbdominaI examination reveaIed two paIpabIe and movabIe kidneys, which were moderateIy tender. PaIpation of the suprapubic area elicited tenderness over the bladder on both moderate and deep pressure. Recta1 examination was negative, as was the examination of both extremities. RefIexes were moderateIy exaggerated. Temperature was 100.8’, puIse IOO and respirations 20. Three days after admission, routine x-ray examination of the genito-urinary tract, showed marked biIatera1 nephroptosis, with the shadow of a Iarge round caIcuIus in the bIadder. (Fig. I.)

Acute retention of urine

CUTE retention of urine represents A a highIy significant cIinica1 syndrome as encountered either by the Internist, surgeon or uroIogist. Inabihty to pass any urine per urethram after repeated attempts at voIuntary micturition may sound a danger signa warranting not mereIy reIief of immediate symptoms but careful investigation for underIying pathoIogy. Too often the effect is treated with utter disregard of the cause. Morbidity and mortaIity wouId be markedIy diminished if cause and effect were reveaIed and suitabIe therapy instituted. Any obstructive Iesion of the Iower ‘urinary tract, from interna sphincter to externa1 urethra1 meatus, may account for compIete interruption of the urinary .stream. Apart from the dynamic mechanica1 types, one may encounter adynamic neurogenic Iesions. It wouId be more accurate in defining acute retention of urine to incIude the upper urinary tract. This broader interpretation is expressed as the inabiIity of the renaI peIvis, ureter or bIadder to discharge any of its urinary contents. One should be mindfu1 of the fact that acute inffammation with its attendant edema, either independent of, or superimposed upon anomaIy, neopIasm or caIcuIus of the kidney, renal pelvis, ureter or bIadder, is capabIe of producing acute IocaIized urinary obstruction. Associated with such unilatera1 pathoIogy is the ever-present danger of reflex inhibition of urine on the opposite side, or even absence of the kidney, a finding noted in 0.04 to 0.1 per cent of a11 individuaIs. For purposes of simpIicity, however, we shaI1 confine our presentation to the Iower urinary tract. It is aIso beyond the scope of this paper to discuss chronic retention of urine. In YORK