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Hematuria is always an alarming symptom and its cause must be carefully sought by the conscientious physician. If there are repeated short spells of bleeding a malignant lesion somewhere in the urinary tract should be suspected. When the bleeding is associated with dysuria and occurs in the earlier part of life, a tuberculous infection would be a more probable cause; if bleeding is accompanied by severe colic, the presence of calculus is suggested. When hematuria is painless and of long duration, disappearing for weeks at a time, the possibility that it is of the so-called idiopathic or essential type must be considered.In order to make this diagnosis, cystoscopic examination is necessary, at which, all other causes of bleeding being excluded, a diagnosis of essential hematuria is reached by the process of elimination. Some urologists are of the opinion that such a diagnosis serves as a cloak for ignorance of

A perusal of the literature or of statistics relative to malignancy of the bladder inevitably leaves the reviewer with three major impressions: (1) the lack of a uniformity in the classification of tumors of the bladder; (2) the variety of methods employed in their treatment, and (3) the depressingly poor results obtained.Improvement in classification is essential before the value of any method of treatment can be determined. It is obvious that no deductions of value are possible so long as various investigators report their cases under entirely different classifications. Not until a uniform nomenclature has been adopted can the best type of treatment be selected and the final results from such treatment improve.The present confusion with regard to classification is best appreciated after a review of some of the recent reports on malignancy of the bladder. Kidd 1 refers to simple papillomas, inflammatory papillomas, true papillomas, simple primary

The anatomic structure and innervation of the urinary tract lends itself so readily to the application of regional anesthesia that the history of anesthesia in urology becomes necessarily the history of the development of regional anesthesia. In fact, some of the various forms of regional anesthesia were first employed in the treatment of urologic diseases.As in the case of ether, so with regional anesthetics the discovery of its anesthetic properties occurred many years before they were applied in medicine because those making the discovery did not appreciate the importance of it.In prehistoric times the natives of Peru were cognizant of the anesthetic qualities in coca leaves; they were chewed and the saliva was allowed to run into the incision while the famous trephine operations were being performed.Schezer obtained some of these when on his scientific voyage around the world in the Austrian frigate Novar, and observed that

The possibility that renal tuberculosis, once it has reached the point at which diagnosis is beyond question, ever heals has received considerable discussion during the last fifteen years. In 1920 Chute1 reviewed three cases that occurred in his practice; he considered that there were indications in occasional cases that tuberculous processes of the kidney healed. He pointed out how such a belief is necessary if one is to accept the hypothesis of the hematogenous route of the infection. He says:I believe we must assume that tubercle bacilli are brought in approximately equal numbers to both kidneys, that small cortical tuberculous infections are common and that far from going on to complete destruction of every kidney that is infected they are probably promptly stamped out in the greater majority of instances. The generous blood supply of the kidney allows it to overcome perhaps the greater number of infections while

The earliest attempts to correct urinary obstruction, the result of prostatic hypertrophy by major surgical means, consisted in the transvesical resection of that portion of the hypertrophied gland projecting into the bladder. When only this portion of the gland was causing the obstruction the results were good, but as in most cases of intravesical hypertrophy intra-urethral hypertrophy is associated, the symptoms were frequently not relieved because the intra-urethral obstruction remained.For this reason the idea developed that partial removal of the prostate gland was not sufficient, and that to accomplish relief the entire organ had to be removed in addition to the portion that was causing the obstruction. This dictum was generally accepted, although it seemed strange to certain observers that a gland weighing from 20 to 30 Gm. had to be completely removed simply because a small part had begun to obstruct so accessible a channel as the prostatic

The so-called false or acquired diverticula of the small intestine have been of very little interest to clinicians because of their supposed rare occurrence and also because it was thought that they rarely or never give rise to any clinical symptoms.The following case with multiple mesenteric diverticula of the small intestine shows that, apparently, even in these heretofore considered benign diverticula inflammatory changes may occur which may give rise to clinical symptoms and even endanger the life of the individual. In this case, apparently, one of the diverticula became inflamed and a diverticulitis occurred, causing a partial obliteration of the diverticulum. As the diverticulum extended between the folds of the mesentery, the later became inflamed, thickened and puckered, thus causing an angular bending of the intestine and obstructing its lumen. The local peritonitis arising as the result of this gave rise to the formation of adhesions between the mesentery

It is generally recognized that the removal of urine from a chronically overdistended bladder is often followed by untoward symptoms, or death. If the bladder is emptied rapidly and completely at one time, the sudden reduction of the intravesical pressure results in immediate congestion throughout the urinary tract, with resulting edema and hemorrhage, which may be so severe as completely to suppress renal function by increasing the pressure within the renal capsule to a point incompatible with glomerular and tubular function. Even though the process may not go on to complete suppression of urine, the congestion and edema make the urinary tract a fertile field for infection, a complication which is borne very poorly by this class of patients, and is the undoubted cause of many of the fatalities.O'Conor1 has shown that, coincident with emptying the bladder of residual urine, there is a decided fall in blood pressure.

Each year, in the urologic section of the Mayo Clinic, more patients are seen than in the year before who state that they have been informed that a kink in one of their ureters is responsible for their rather indefinite symptoms and that its surgical correction is urgent. On general examination, evidence of renal ptosis is not demonstrable and pyelograms fail to show the kink previously pointed out to the patient.This discrepancy has occurred so often that we recently reviewed our old pyelograms in order to ascertain the frequency of ureteral kinks. We were astonished to find how frequently a kink would be present in one roentgenogram but absent in a subsequent exposure, although the identical portion of the ureter might have been exposed but a few minutes later.The literature contains several articles calling attention to the part that a ureteral kink may play in the production of

Efforts to dislodge and recover ureteral stones by the manipulation of multiple ureteral catheters, dilators or sounds have been surprisingly successful, and major surgical procedures have decreased accordingly. It is generally agreed, however, that in a certain number of cases the stone will be too large to pass, and an initial operation will be indicated. The opinion among urologists that attempts should not be made to manipulate certain stones is due to the fact that occasionally a patient develops periurethritis or pyelonephritis afterward, becomes acutely ill, and requires nephrectomy. In such a case the removal of the badly infected kidney might have been avoided if surgical measures for the removal of the ureteral stone had been undertaken at the beginning. Even with this problem solved, there still remains the problem of the type of operation to be employed for removal of the stone. If nephrectomy is not required and the