A METHOD OF SECURING URINE FROM THE URETERS WITHOUT CATHETERIZATION.
I desire now to speak briefly of a novel development of my method of examining the bladder and exposing the ureteral orifices, that is, the securing of urine direct from the ureter, without passing over the surface of the bladder and at the same time without introducing a catheter.
Oftentimes it will be deemed inadvisable to catheterize the ure ters, in cases in which the bladder is inflamed or contains infectious material, on account of the danger of conveying the disease on the point of the catheter from the bladder to the ureter, producing pyo ureter, pyelitis, and pyelonephrosis. In these cases I have been able to dispense with the catheterization of the ureter and gather a small quantity of urine by a very simple device.
It is evident that for the purpose of urinalysis, obtaining specific gravity, and making microscopic and bacteriological examinations, a few drops of urine is as serviceable as a large quantity. When the difference is marked between the urine from the two sides this demon stration is particularly satisfactory. Two methods may be em ployed : in one the patient is placed in the knee-breast position, in the second she lies in the dorsal position without elevation of the hips.
To examine the patient in the position, the only special instrument needed is a speculum, a centimetre longer than the ordi nary, and cut off obliquely at the end. The ureteral orifice is found as described, and care fully cleansed with a small pledget of cotton, saturated with a warm boric acid solution, ap plied by means of mouse-tooth forceps. The orifice of the speculum is now pressed gently up against the bladder wall so as to bring the ureteral orifice about in its centre. This gentle
pressure is kept up for five or ten minutes, during which time all the urine escaping from the ureter runs directly into the speculum and down its sides to the outer edge, where it is either allowed to drop into a small graduated glass, or is taken up with a bit of cotton and squeezed into a little sieve, through which a drop or two of urine is expressed out of the cotton into the glass below. This is reserved for the exami nation. If the other side is to be examined in the same way, the speculum must be cleansed and re-introduced, and the urine collected after cleansing the area around the ureter. When the secretion of urine is active—I have seen it spurting in jets—it will only be neces sary to hold the speculum up under the ureteral orifice without touching the bladder wall, in order to catch all that will be required for the examination.
To secure urine, from the patient in the dorsal position, without catheterization, the bladder is emptied of urine as completely as possible with the catheter. Then the ordinary No. 10 speculum is introduced and the ureteral orifice sought by sliding the speculum over the bladder wall, making sufficient pressure to keep out the residual urine in the bladder. When the orifice is found, the speculum is pressed gently down on the mucosa, which is carefully cleansed with a pledget of cotton. The urine then appears in little jets at intervals, and is taken up on a small pledget of cotton. If the patient be thin, and the hips elevated in the dorsal position, the exami nation will not be impeded by the residual urine from the bladder working in under the edges of the speculum.