PATHOLOGY OF THE P,ENAL PELVIS AND OF THE The disposition of the renal pelvis and of the ureters may be dif ferent. There may be no renal pelvis at all, but the renal calyces may enter directly into several tubes eonneeted with the ureter. The con genital anomalies of greatest practical iinportanee are atresia (atresia ureter° vaginalis, uretero uterina, uretero urethralis), and the formation of valves, since these conditions result in the formation of hydronephrosis.
The prolapse through the urethra of a blind ureteral mouth pro jecting into the urinary bladder like a blister, requires brief mention. More than forty sueh eases have been described. The prolapse may be complete or incomplete, the fortner being only possible in the female sex. The perfectly developed anomaly presents itself as a dark red tumor which may be the size of a hen's egg, which enlarges under press ure, is diminished by compression, and feels like a flabby bag. The latter quality differentiates it from solid tumors of the bladder. The origin of the turnor-like mass may be determined by exploration with a probe. The symptoms are similar to those of inversion and prolapse of
the utinary bladder. The symptoms of incomplete prolapse, whieh recognized by cystoseopic examination are like those produced by calculi (Weinleehner). In some eases it is imposible to distinguish between this condition and prolapse of the bladder. If the mouths of the ureters are visible, the former condition is present. If a kidney enlarged by the formation of a hydronephrosis ean be detected by pal pation, it is probable that. an impervious ureter diverticulum is present.
The affection is the result of a congenital deformity of the end of the ureter.
Treatment consists in re-establishing the communication between the bladder and the elosed up ureter. The danger of the condition con sists in the poisibility that symptoms of strangulation may appear, and in the disposition of the prolapsed membrane to inflammatory disease with extension upward.
The inflammation of the renal pelvis, pyelitis, will be discussed along with the cystitis to which the affection is closely related.