WASHING OUT THE URETERS AND PELVES OF THE KIDNEYS.
I shall notice briefly, as but indirectly pertaining to my subject, one of the most important developments of this method of investigation. I have found that by means of the catheter introduced into the ureter, con nected by a long, delicate rubber tube with a funnel, I am able with ease to wash out the urinary tract up to and including the pelvis of the kidney. The cases in which I have been called upon to do this have been cases of hydro-ureter with stricture at the vesical end of the ureter, and of pyoureter with pyelitis, also with stricture at the lower extremity, and one case of colon-bacillus infection of the right ureter and pelvis. The patient is put in the knee-breast position, and the catheter, with a short piece of rubber tubing attached, is filled with a saline or boric acid solution, and clamped to keep the solution from running out. The catheter is now intro duced into the ureter at least 5 or 6 cm. (2 or 3 in.) and the speculum withdrawn. A funnel or graduated tube with a piece of rubber tubing about 30 to 40 cm. (12 to 16 in.) long, having attached to it a glass point drawn sufficiently fine to allow of its introduction into the tube on the catheter, is now filled with solu tion and connected with the catheter. By raising the funnel above
the level of the body, the fluid is made to flow into the ureter and up into the kidney ; by dropping it well below the level of the body, it rims out again. In this way the fluid can be made to run in and out at will, or fresh fluid can be used each time.
The procedure is painless to the patient, who is able, however, from a little discomfort in the renal region to guide the operator in estimating when a proper amount of distention has been reached.
When the ureter is distended by pus or urine, this must be with drawn before running in the fluid.
One urgent word of caution is necessary regarding all these ure teral manipulations, and it applies with especial force to the cases in. which infection already exists. It is the constant necessity for pains taking care in making the manipulations gentle throughout. Any roughness or pushing past obstructions, or endeavors to push the catheter up higher than it will readily go, will quite certainly injure the mucous coat of the ureter, and be apt to be followed by a sharp chill and fever, persisting from a few hours to several days.