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Anomalous Lesions of the Upper Urinary Tract

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Abstract

Before the use of excretory urography and retrograde pyelography, anomalous lesions of the upper urinary tract were seldom diagnosed. In this paper we are presenting illustrated case histories of several of these anomalies, namely, ectopic kidney, fused kidney, solitary kidney, and ureteropelvic obstruction producing hydronephrosis. Some general concepts are applicable to anomalies of the upper urinary tract:

  1. These anomalies are seldom suspected from the history or physical examination.

  2. Urinary signs and symptoms may be absent.

  3. Secondary complications are common.

  4. These anomalies frequently produce referred abdominal symptoms ranging from vague dyspepsia and backache to symptoms of peptic ulcer, appendicitis, and gallbladder disease.

  5. If not diagnosed before operation, these anomalies will complicate renal surgery.

  6. Diagnosis is established by intravenous urography or retrograde pyelography.

The value of excretory urography cannot be overemphasized. It is a simple means of studying the urinary tract. The accuracy of diagnosis by this means depends on obtaining satisfactory roentgenograms and using a proper technic. Two general rules should be followed, namely, (1) no dye should be injected before a plain film of the abdomen is made, and (2) excretory urography should not be done within twenty-four hours of cystoscopy or catheterization of the ureters. Opaque shadows may be obscured, or false ones assumed, if a plain film is not available; irritability of the ureter and kidney from instrumentation can cause both to have an abnormal appearance. In exceptional instances a normal kidney may fail to visualize with urography, possibly because of hyperactive. . .


 

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