Hematuria : a study from the practitioner's standpoint / by Victor Cox Pedersen.

  • Pedersen, Victor Cox, 1867-1958.
Date:
1913
Catalogue details

Licence: In copyright

Credit: Hematuria : a study from the practitioner's standpoint / by Victor Cox Pedersen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of blood is large and the bladder washed until the medium is clear, the blood is seen to spurt out of the ureter like smoke puffs. Ureteral as distin- guished from renal bleeding might be diagnosti- cated by using a small catheter and taking speci- mens from the canal at four or five levels until clear urine from the pelvis is reached. If, however, the bleeding proceeds from the ureteral pelvis, such a procedure would fail in the presence of what would then be clinically renal hemorrhage, so that such a distinction would be of theoretical rather than prac- tical importance. Neoplasm as a source of renal hemorrhage re- quires the earliest possible recognition while the tu- mor is impalpable, insensitive, and nonadherent, be- cause when it is palpable, tender, and fixed, it is commonly beyond operative intervention. Renal sarcoma occurs in childhood, carcinoma in midlife, and hypernephroma and the mixed neoplasm of Wilms at almost any age. Hemorrhage is least fre- quent with sarcoma. In the other neoplasms it is active, precipitate, and profuse, earlier from the re- nal pelvis than from the parenchyma, commonly in- creased by exercise and motion and unaffected by repose, with a urine devoid of nephritic elements and rarely containing tumor detritus. Ureteral colic due to clots is not the rule, and pain and discomfort are not present in the operable stage in any marked degree. Cystoscopically the mouth of the ureter is normal. The diagnosis should be made so early that there is no cachexia from hemorrhage and no rise in temperature or absorption from the cancer. The importance of a complete diagnosis in renal hemorrhage is illustrated by the following case of hypernephroma, operation, and death nearly a year after I had examined it and made a diagnosis of syphilis of the bladder with hemorrhage, without, however, ureteral catheterism. Active antisyphi- litic measures seemed to have stopped the hemor- rhage and improved the urine and bladder, and the general health. After rather a long period of com-