Gigantic Hydronephrosis with Hydroureters, Congenital

Abstract

Very large ureters, with the usual large kidney pelvis and calices, are seen frequently enough, occurring on one side. A careful examination will usually disclose some obstruction in the urinary tract, either a blind end of the ureter leading into an abnormal position, such as the rectum, or an imperforate anus. Tumors, strictures, and inflammatory conditions may cause obstruction, anywhere in the urinary tract, to the flow of urine through the ureters. Supernumerary kidneys, with displaced, dilated ureters, have been found. In fact, any obstruction sufficient to hinder the flow of urine through the urinary tract will dilate the obstructed area. Proven congenital cases of hydroureters and hydronephrosis are rare. Wilhelm Tinnemeyer (Zeits-chrift fur urologischen Chirurgie, 1922, p. 50) mentions Gerster's case of horseshoe kidney, with a very large left ureter leading into an imperforate anus. In the same article (p. 58), the postmortem of a male child thirteen days old is reported as showing ureters the size of a lead pencil, with kidneys larger than normal. At the entrance of the ureter into the bladder only the thinnest filiform bougie could be passed. Braasch has reported a case of hydronephrosis and hydroureters as follows: “The dilatation is marked from the meatus to the renal pelvis. The dilatation in the pelvis is predominatingly in the calices; no obstruction is found; the condition is evidently one of congenital atonic development.” Again, the same authority mentions a case of solitary kidney with a large ureter. I wish to put on record the following case: Male child, white, ten years of age, was admitted to the hospital on October 1, 1923. He was a well-formed child of normal size, giving an impression of being healthy. The family history was good and the brothers and sisters of the patient were well. He had weighed nine pounds at birth; had had measles and mumps in early childhood. About five years before the date of examination the mother had noticed some pus in the boy's clothing. Shortly after this he began to suffer with nocturia and a little later incontinence began, which was exaggerated during excitement. The child continued to look well and did not complain. At this time he was examined by physicians, but without benefit. One year later the boy contracted whooping cough. The pus from the urethra became plentiful, and for a time the boy seemed weak and to lose desire to play. At this time cystoscopic and X-ray examinations were made, the diagnosis being a stone in the prostate. The plate showing the supposed stone was shown me by the father; the shadow seen is that of the child's penis. Dr. Lund found on cystoscopic examination, under general anesthesia, normal external genitalia, slight cystitis, no tumor or foreign body. The orifices of the ureters were wide open and would probably have admitted a finger. A catheter passed freely on both sides. A free cloudy drainage was obtained, which, in culture, showed no growth.