. American journal of obstetrics and gynecology. cystocele; (hour glassformation of the bladder) 2. Intramural stretching in the bladder wall with stenosis. 3. Compression of the ureters outside the bladder. Kinking of the urethra was given as a cause by Froriep. If thiswere the rule, however, these j^atients would suffer from great urinary BRETTAUER AXD RFBIX : HYDROFRETER AND HYDRONEPHROSIS 699 difficulty, which is not common. On the contrary tliere is more aptto be incontinence. Furthermore, as Tandler and Halban remark, thestasis of the ureter begins above the hiatus genitalis. If the latt
. American journal of obstetrics and gynecology. cystocele; (hour glassformation of the bladder) 2. Intramural stretching in the bladder wall with stenosis. 3. Compression of the ureters outside the bladder. Kinking of the urethra was given as a cause by Froriep. If thiswere the rule, however, these j^atients would suffer from great urinary BRETTAUER AXD RFBIX : HYDROFRETER AND HYDRONEPHROSIS 699 difficulty, which is not common. On the contrary tliere is more aptto be incontinence. Furthermore, as Tandler and Halban remark, thestasis of the ureter begins above the hiatus genitalis. If the latteris wide the ureters are not dilated, though the cystoeele may bemarked. When the ureter empties into the bladder at a point abovethe hiatus genitalis it is also not dilated. Intramural stenosis of the ureter probably is not the cause of ureterdilatation, because the distal portion is normal for two or three centi-meters from the bladder wall. This latter fact indicates the pointof compression to be from outside the bladder. Tandler and Halban. -Constriction of the distal portion of the ureter by tlio uterine arterj- andveins in genital prolapse (.schematic). maintain this to be the edge of the levators which form the hernialring of the genital prolapse. Their anatomic specimens apparentlyillustrate the point made by them. Inasmuch, however, as the levatorsare frequently so stretched as to be very thin, weak muscle bands,while on the other hand the bladder capacity varies frequentlythroughout the day, this cause is more apparent than real. Were thebladder a solid organ it would with the uterus form a sufficient bodyto cause constant and effective compression of the ureters againstthe levators, resulting in stenosis and dilatation. In the absence ofthis factor, the bladder would have to be filled constantly with a 700 THE AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY sufficient quantity of urine to produce hydrostatic pressure on certainfixed points of the ureters. Owing to the
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