Treatment of Juxtavesical Ureteral Calculi with Lumbar Sympathetic Block

In experiments on dogs, Tanagho, Hutch, Meyers & Rambo (1965) produced vesico-ureteral reflux by surgical lesion of the muscles of the trigone of the bladder or by interruption of the sympathetic nerves supplying these muscles. In view of these results we found that it would be worth while, in patients with juxta-vesical ureteral calculi, to try to produce paresis of the smooth muscles of the trigone and ureter by means of lumbar sympathetic block in order to promote the passage of the calculi. In two patients with a long history of symptoms, juxtavesical calculi passed almost immediately after a lumbar sympathetic block. However, in a systematic study of the method in a series of 35 patients with juxtavesical calculi, in which the results were compared with those obtained in an equally large control group which was otherwise given the same treatment, it was not unquestionably demonstrated that the passage occurred earlier or more frequently. It is concluded that nevertheless it will be reasonable to try lumbar sympathetic block once or twice before resort is taken to surgical removal.