The Demonstration and Significance of Nephroptosis and Urinary Stasis

IN the study of urinary stasis of the upper urinary tract, one must be familiar with the normal anatomic relationship of the kidneys and other organs, as well as the supporting structures of the kidneys. The recognition of nephroptosis, and the various forms of treatment for the same, is as old or older than urology itself; however, the roentgen-ray demonstration of nephroptosis is a more recent development. It is the purpose of this thesis to again call attention to the anatomic relationship of the kidneys and other organs, as well as the supporting structures of the kidneys, the histologic structure of the renal pelvis and ureter, also the physiologic action of the renal pelvis and ureter. As there may or may not be a stasis of urine in the renal pelvis, as a result of nephroptosis, a method is proposed for determining this factor which should be carried out in cases in which investigation of the higher urinary tract is indicated. As shown by Southam (1), the kidneys lie in the lumbar region on either side of the vertebral column. Each kidney occupies the upper third of the lumbar fossa, a space which is bounded behind by the muscles of the loin and back, in front by the peritoneum, above by the diaphragm, and below by the ilium. The kidney extends from the upper margin of the twelfth rib to the lower margin of the second lumbar vertebra. The kidneys are situated entirely behind the peritoneum, and the right kidney lies about a finger's breadth lower than the left. This is said to be due to the fossa on the right side being less capacious on account of the presence of the liver and an inclination of the vertebral bodies to that side. The peritoneal relations are somewhat different on the two sides. On the right side the peritoneum passes from the liver to the anterior surface of the kidney; the lower third of the kidney is not covered by peritoneum. The area of the left kidney covered by the peritoneum is far less than that of the right kidney. The upper third of the left kidney is related to the stomach, while the pancreas crosses its middle third; the lower third is covered by peritoneum and related to coils of small gut, the outer border being related to the spleen above and the colon below. The upper two-thirds of the right kidney is covered by the under surface of the liver, the lower third by the hepatic flexure of the colon. The inner border is related to the duodenum. The posterior surfaces of the ascending and descending colon are not covered by peritoneum, and hence the gut comes into relation with the perirenal fascia. The suprarenal gland rests upon the upper pole of the kidney, while posteriorly the kidney lies upon the quadratus lumborum and psoas muscles, the diaphragm, and the transversalis aponeurosis. If the lumbar regions be examined from behind, it will be seen there is a difference in outline in the two sexes.