Joseph A. Hyams

Chronic ileitis with concomitant ureteritis: Case report

A CAREFUL search reveals that whiIe over a thousand cases of regional, nonspecific enteritis have been reported from all over the worId, no cases of uroIogic compIications have been previousIy cited. In the decade since the disease was described by Crohn and his co-workers, no definite etioIogica1 agent has been found. According to present knowIedge from a study of the diseased tissues, the underIying disturbance is an infectious process that gives rise to a nonspecific, granuIomatous reaction. The area affected is usuaIIy the termina1 iIeum but other parts of the iIeum and jejunum have been described as being similarly invoIved. As the disease progresses, there is a characteristic formation of feca1 fistuIas. These are caused by a Iytic change induced by inflammatory processes and the fistuIas most frequently seen are peri-ana1, perirecta1, rectovaginal, or burrowing into a previous Iaparotomy scar. It is of interest to urologists to note that no fistuIas have been reported draining into the Iumbar area. Another characteristic change is the formation of Iarge, inffamed gIands draining the infected area. It is possible that in this case report about to be presented of a concomitant ureteritis with a regiona iIeitis, the infecting agent spread to the ureter via the Iymphatics of the lower ureter which drain into the hypogastric pIexus and from there an anastomosis with the inferior mesenteric gIands is possible. The infrequency of uretera compIications with ileitis suggests the fact that this lymphatic anastomosis between the intestines and the ureter is either a rarity, NEW YORK

Modification of the munro tidal drainage apparatus

W HEN Munro first presented his conception of tida1 drainage of the urinary bIadder in 1934, it apparentIy was not evident to the uroIogists discussing the paper that this method of treatment had uroIogic significance. However, it was soon discovered that this was a valuabIe and dependable addition to their therapeutic armamentarium, and modifications of the origina apparatus for specia1 cases were devised. We wish to present two such modifications: the first having very genera1 application and the second a very Iimited one. Tidal drainage was first utiIized by the uroIogist for the treatment of cystitis, particularly in those obstinate cases which did not respond to recognized measures. The value of the treatment Iies in the regular, automatic distention and irrigation of the bladder. With the origina apparatus, the reservoir and tubing had to be fiIIed at each cycIe before any fluid entered the bIadder, and the evacuation of the viscus was sometimes incompIete. It was evident that with constant irrigation the modaIity wouId be more effective. For this purpose, the modification shown in Figure I was devised. EssentiaIIy, it consists of a twoway catheter with tidal drainage apparatus attached to the outflow. AI1 the ffuid entering the apparatus must first pass through the bIadder. ActuaI tests have shown that a soIution of indigo carmine wiI1 be cIeared from the bladder in haIf the time that is required with ordinary tida1 drainage. This modification is vaIuabIe in the treatment of a11 types of cystitis, but particuIarIy so when the urine is markedly infected or when incrustations are present, and perDENVER, COLORADO

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.)

Diagnosis and treatment of stricture of male urethra

Abstract For the diagnosis and treatment of the varied types of stricture, urethrocystography, the roentgenographic delineation of the urethra and bladder with the use of an innocuous contrast medium is invaluable. It may be used alone, or to supplement other methods of diagnosis. Associated pathologic lesions of the urethra and glandular adnexa are graphically delineated by this method. The treatment of stricture is based on a knowledge of the etiological factors and the degree and extent of pathology present. Most strictures respond to gradual dilatation and other office procedures. The prevention of venereal disease and a better understanding of the need for early and adequate treatment will aid in the further reduction in the occurrence and severity of strictures.

Modern treatment of chronic urethritis

Abstract 1. 1. Chronic urethritis is preventable in the majority of cases. 2. 2. Chronic urethritis is essentially a urologic entity, entirely apart anatomically and clinically from its precursor, acute anterior urethritis. 3. 3. Cure is dependent on our ability to locate infected foci, and having located them, to eliminate or destroy the gonococci, and restore tissues to their normal condition if possible. 4. 4. Cooperation of the patient must be secured and is predicated on our imparting to him the knowledge requisite to his understanding the serious nature of his disease and its treatment. 5. 5. The successful treatment depends on conditions and circumstances and the reaction of tissues to it, and nowhere in the realm of medicine or surgery is the maxim of Aristotle more appropriate than when used with reference to the treatment of chronic urethritis: “Not too much, not too little.”