The fluid contained in the sac is usually a clear, thin, yellowish, watery urine. Its composition, however, varies. The specific gravity is low, and the re action is often slightly alkaline. Traces of albumin, urea, and uric acid are found, although in long-standing cases the lat ter two ingredients may be absent. Tur bidity may be observed, owed to admixt ure with pus, blood, or epithelium, but only in instances in which previous in flammatory conditions—as a calculous pyelitis — or local complications — as hemorrhage, suppurative inflammation, and the like—have existed.
Prognosis. — In unilateral hydrone phrosis, the more common variety, the prognosis is guardedly favorable, on ac count of the establishment of compensa tory function on the part of the un affected kidney, and this is particularly true if the case be one of movable kidney. The bilateral affection is always grave, having about the same outlook as chronic pyonephrosis. Among danger ous accidents and complications may be mentioned urminia, rupture of the sac, and infection of the cyst by pus-organ isms. Recovery may ensue in rare in stances in which a spontaneous discharge of the fluid occurs.
Treatment. — The congenital form, when bilateral, is not amenable to treat ment. It is rarely feasible to force the fluid out by manipulation of the tumor. This method tends to remove the occlu sion, when caused by a slight twist or kink in the ureter. In unilateral hydro nephrosis, carefully tapping the cyst may be practiced, thus overcoming the me chanical discomfort. Operative interfer
ence, with a view to removing the special obstructive cause, is also to be encour aged and advised in suitable cases.
Double lumbar nephrotomy performed at the twenty-second hour after birth for congenital hydronephrosis. The child, several weeks after the operation, was still living and passing all his urine through the lumbar fistula. Henry Morris (Lancet, Jan. 27, '94).
In acquired hydronephrosis sympto matic treatment only is required in moderate enlargements, though some times gentle massage over the sac, prop erly directed and cautiously applied (to avoid rupture), may cause a reduction in the size of the cyst. In the majority of instances surgical measures only are of use. Repeated aspiration of the sac has in a few reported cases accomplished a cure. Surgical measures also embrace nephrotomy and drainage, rhaphy (particularly when caused by movable kidney), and nephrectomy.
Nephrectomy advocated for hydrone phrosis. J. Bland Sutton (Clinical Jour., Nov. 1.5, '931.
Case of intermittent hydronephrosis in a child successfully treated by operation. All that was discovered was a movable kidney. This was tethered, and in a few weeks the patient was entirely free from the previous trouble. The cure proved to be permanent. Setske (Australasian Med. Jour., Apr. 20, '99).
In no cases in which the symptoms are mild should surgical procedures be un dertaken, as in some instances of the in termittent variety.