An American text-book of genito-urinary diseases, syphilis and diseases of the skin . ed the patency of the ureter by the following operation :A lumbar extra-peritoneal incision was first made into the sac, but the ureter could notbe found. The lower end of the sac—the dilated pelvis—was then incised, on theupper border of which was seen a layer of kidney-substance the thickness of a thumb. VALVE-FORMATION, BENDS, AND STRICTURES. 513 The ureter could now be seen running several centimeters in or upon the posterior wallof the sac and terminating in a slit in the pelvis. On attempting to introdu
An American text-book of genito-urinary diseases, syphilis and diseases of the skin . ed the patency of the ureter by the following operation :A lumbar extra-peritoneal incision was first made into the sac, but the ureter could notbe found. The lower end of the sac—the dilated pelvis—was then incised, on theupper border of which was seen a layer of kidney-substance the thickness of a thumb. VALVE-FORMATION, BENDS, AND STRICTURES. 513 The ureter could now be seen running several centimeters in or upon the posterior wallof the sac and terminating in a slit in the pelvis. On attempting to introduce a fineprobe into the ureter a stricture was encountered 2 cm. below the pelvis. As a cure seemed impossible without removing the stricture, the ureter was trans-versely divided below the stricture and at the entrance to the sac. The ureter was nowunited to the pelvis by dividing the upper end of the ureter longitudinally, unfoldingthe divided end, suturing it to the opening into the sac, and closing the remainder ofthe wound in the pelvis by catgut sutures (Figs. 179, 180).. Fig. 179.—Kiisters operation for implantation ofthe ureter into the sac (pelvis): a, upper end of a;b, ureter running in the wall of the sac; a, c, slit inupper end of ureter. Fig. 180.—The divided end of the ureter un-folded, and in the extent of a, b, c sutured to thewall of the sac (Kuster). The next day some bloody urine escaped into the bladder, but ordinarily the urinepassed out through the lumbar fistula. From this time more and more urine passedinto the bladder, until four months after the operation as much as 100 passed in thetwenty-four hours. Four months later the fistula was closed by curetting, dilating, and closing thecanal by tier sutures. In the first twenty-four hours after this operation the patientpassed 1300 of bloody urine from the bladder. He recovered, but with a lumbarhernia which had to be held in place with a bandage; the fistula remained boy was a
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