The pathology and surgical treatment of tumors . ation of the swelling, which indoubtful cases can be shown satisfactorily by rectal insufflation. Inwomen catheterization of the ureters as described and practised byKelly will often enable the surgeon to demonstrate not only the exist-ence but also the exact location of the ureteral obstruction. If theswelling can be located positively in the retroperitoneal space, a lumbarexploratory puncture under strict antiseptic precautions is not onlypermissible but will settle the diagnosis between hydronephrosis andpyonephrosis and malignant tumor of th
The pathology and surgical treatment of tumors . ation of the swelling, which indoubtful cases can be shown satisfactorily by rectal insufflation. Inwomen catheterization of the ureters as described and practised byKelly will often enable the surgeon to demonstrate not only the exist-ence but also the exact location of the ureteral obstruction. If theswelling can be located positively in the retroperitoneal space, a lumbarexploratory puncture under strict antiseptic precautions is not onlypermissible but will settle the diagnosis between hydronephrosis andpyonephrosis and malignant tumor of the kidney. A careful chemicaland microscopical examination of the urine will often indicate the kidneyas the primary seat of the swelling. 696 PATHOLOGY AND TREATMENT OF TUMORS. Treatvieiit.—In unilateral hydronephrosis the opposite kidney under-goes compensatory hyperplasia. Experiments and clinical observationhave shown that one healthy kidney is sufficient to eliminate the urea,and numerous cases have been recorded in which a hydronephrotic. Fig. 487.—Bilateral hydronephr -born child; one-fourth natural size (after Sutton). kidney was removed without any immediate or remote ill results. Thekidneys are, however, subject to so many accidents and diseases thatthere is no excuse for sacrificing a kidney unless its parenchyma hasbeen destroyed or the continuity of the urinaiy passage cannot berestored by some of the operative procedures that have recently beendevised. The writer, who cannot agree with Morris and Sutton that,in the opposite kidney is in a healthy condition, the hydronephrotickidney should be removed, has shown that mechanical obstructionof the ureter in dogs produces progressive hydronephrosis, and , by microscopical examination of the capsule of the cyst,the of atrophic kidney-tissue and the capacity of this tissueto regenerate after a nephrotomy. It is different in cases of hydro-nephrosis complicated by suppurative pyelonephr
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