Renal damage and anuria, in patients being treated with the sulfa drugs, may be the result of true toxic injury to the renal tubules or of urinary obstruction. The latter, in turn, may be intrarenal or ureteral. The case presented represents an example of the latter.
A 61-year-old man reported to Cleveland Clinic on January 2, 1946, complaining of a swelling in the neck. This was thought to be a branchial cleft tumor, probably carcinoma, and operation was performed on January 4. The tumor was found to be partially cystic, but the hard, infiltrated wall could not be entirely removed, so the wound was packed open. On January 6 a secondary closure was made, and the patient was put on sulfadiazine, 1 Gm. every four hours, as a prophylactic measure against infection.
On January 9 at 4 a.m. the patient complained of painful distress in the suprapubic region and was unable to void. The administration of prostigmine and other ordinary measures for inducing urination were ineffectual. Catheterization disclosed no urine in the bladder.
Urological consultation was requested. The man was in acute distress with pronounced suprapubic pain and vesical tenesmus. The bladder was not palpable. There was tenderness in the suprapubic region with slight tenderness in the costovertebral angles. With the history of anuria and pain, bilateral ureteral obstruction was suspected and immediate cystoscopy advised.
Cystoscopy was carried out under pentothal anesthesia. There was no urine in the bladder. Inspection revealed an acutely reddened and edematous mucosa with. . .