Lesions by bullets, arrows, stabs, bruises and lacerations in
parturition, treads, wheels, tumors, ulcers, calculi, tubercles,
parasites. Course. Pathology: transverse division may cause
hydronephrosis, or septic peritonitis. Symptoms: uncertain,
traumatism, bloody urine, arched, stiff, tender loins, straining,
recumbency, groaning in turning or rising, rectal palpation of
distended ureter, of ascitic fluid, pitting on pressure of loin, flank
or groin, liquid drawn through a cannula is urinous, urine still
discharged by normal channel. Crystals in urine, worm ova. Treatment:
compresses, fomentations, sinapisms, anodynes, balsams,
antispasmodics, extraction of calculus, lateral implantation of
urethra.
From their deep and protected position it might be plausibly concluded
that the ureters were secure against every kind of traumatism. This
however, is not the case, since in both man and animals they have been
known to have been injured by bullet wounds, arrow wounds, and stab
wounds of various kinds. In dystokia with laceration of the womb, vagina
or bladder the ureter is liable to be injured. By blows and kicks it may
even be ruptured or torn across, and also by sudden and severe
mechanical compression of the abdomen as when run over by a wagon or
trodden on by a horse, ox, or other large animal. Tumors of various
kinds may grow in, or press upon the ureter, ulcers with thick indurated
margins or base may obstruct the passage, or calculi, or worms may block
and give rise to overdistension and even rupture. Kopp describes
obstruction by multiple calculi with saccular dilation in front, close
to the kidney in a cow. Cadiot records cases of thickening of the mucosa
by numerous cysts as small as hempseed. Intra-abdominal tumors of the
spermatic cord have been known to block the passage. Again tubercles
have formed on the urethra, and polypi on the trigonum vesicæ have
blocked the ureter and produced all the evil consequences of calculus,
parasites, etc.
_Course._ The progress of the disease will vary greatly according to the
nature of the lesion. With complete rupture of the ureter the urine as a
rule escapes into the peritoneal cavity. If the urine is aseptic this
may not lead to serious results and the edges of the wound cicatrizing,
the urine is imprisoned in the ureter and pelvis of the kidney, and
leads to final atrophy of the kidney and hydronephrosis. When on the
other hand infecting matter escapes with the urine, as in perforating
ulcer, tubercle, glanders, cancer, infective catarrh of the kidneys or
ureter, such infection is brought in contact with the whole peritoneal
surface, where secondary infections follow. In cases associated with
penetrating wounds, wounds resulting from dystokia, calculus or
parasitic obstruction, similar infection is to be dreaded.
The _symptoms_ are by no means clear, unless the injury result from
external traumatism, or when it can be detected by rectal exploration.
There may be blood staining of the urine, stiffness of the loins,
lameness in one hind limb, tenderness of the lumbar vertebræ and of
their transverse processes on pinching, frequent straining to pass
urine, a disposition to remain recumbent, pain and groaning when rising,
or when turned in a narrow circle. Under rectal examination the blocked
ureter may sometimes be recognized, its cystic end shrunken and empty,
up to the seat of obstruction, and its renal end, from the
hypersensitive seat of obstruction forward, full, rounded, elastic and
firm. If the ureter has been ruptured, it may be impossible to
distinguish it, but the presence of urine free in the peritoneum may be
detected through the rectum as it may often be through the abdominal
walls. Sometimes the urine infiltrates the subperitoneal connective
tissue, and forms a pasty swelling on the loin or flank. In either case
a hollow needle inserted will draw off a liquid having an urinous odor.
That this urine has escaped in front of the bladder may be safely
inferred from the continued discharge of urine by the urethra and by the
absence of cystic swelling, heat and tenderness. If the kidney can be
reached by rectal exploration it is felt to be firm and resistent up to
the period of rupture of the ureter.
In case of obstruction by calculus, crystals and even small calculi may
be passed in the urine, there is usually a history of previous attacks
of renal colic, and the suffering is manifestly extreme. In case of
worms (strongylus gigas) the use of the centrifuge on the urine, may
possibly secure in the sediment specimens of its ova. The existence of
tumors or tubercles can usually be clearly made out.
_Treatment_ will be as varied as the lesion. Simple ureteritis may be
met by wet compresses, sinapisms, and internally by balsams and
anodynes. Calculi and parasites may be passed with some aid perhaps from
fomentations, antispasmodics, and diluents. Obstinate cases can only be
successfully met by surgical interference. The resulting wounds in the
ureter, like ruptures, perforating ulcers and strictures may be met by
Van Hook’s “_lateral implantation_”: the divided cystic end of the
ureter is ligatured and on the cystic side of the ligature a
longitudinal incision is made, large enough to admit the divided
extremity of the renal portion, and through each of the two sides of
this last a fine ligature is passed; these ligatures are then passed
into the lumen of the cystic portion of the ureter through its
longitudinal incision and brought outward through its walls; next the
renal end is inserted into the incision in the cystic end and the two
are firmly sewed together by the two ligatures. When a small portion of
an ureter must be excised it may sometimes be possible to save a
valuable animal by such an expedient.
In some cases of rupture into the vagina or uterus an available fistula
may sometimes be established into one of these.