Talk:Paper - Spindle-shaped dilatations and tortuosity of the ureters in the fetus (1902)

SPINDLE-SHAPED DILATATIONS. ° 125

SPINDLE-SHAPED DILATATIONS AND TORTUOSITY OF THE URETERS IN THE FETUS.!

C. A. Hamann, M.D. (Cleveland, Ohio.)

Certain peculiarities in the fetal ureters which I had noticed from time to time and had not seen referred to in the commonly used text-books, led me to make a number of dissections to determine the frequency of these peculiarities.

Among thirteen fetuses whose age was from seven to nine months, the ureters presented more or less distinct spindleshaped dilatations in all but two (2). The spindle is usually larger on the right than on the left side, in two (2) it is only present on the left side, and in three (3) only on the right.

There was no difference in the sexes as far as could be learned.

Where the ureter crosses the iliac vessels and is bent upon itself there is a slight narrowing, and the enlargement extends for from one and one-half to three centimeters. The dilated portion is from one and one-half to two and one-half times as great in width as the rest of the ureter, and is flattened out.

In three of these fetuses the ureter has serpentine curves, or is tortuous. In my experience curves and tortuosities of the ureters are more frequent in younger fetuses.

In none of the fetuses examined were there any evidences of atresia in the urinary tract.

Among twenty-two fetuses, varying in age from three to seven months, there are spindle-shaped dilatations or tortuosities or both, in all but four (4). The spindles are nearly always just above the point where the ureter crosses the pelvic brim.

The curves are sometimes long and serpentine, at other

1 Read, March 28, 1902, at the Second Annual Meeting of the American Association of Pathologists and Bacteriologists, Cleveland, Ohio. 126 HAMANN.

times the ureters are quite tortuous and spirally curved; occasionally there are from two to four corkscrew turns near the kidney.

In but four cases does the ureter followa perfectly straight course from the kidney to the pelvic brim without dilatations.

It would seem from the above statements that it is justifiable to conclude that spindle-shaped dilatations and tortuosities of ‘the ureter are nearly constant in the fetus, and are therefore normal.

If we may be permitted to speculate as to their causation, we might say that the dilatation just above the brim of the pelvis is due to obstruction to the escape of urine from the slight narrowing, and from the curve of the ureter as it crosses the iliac vessels. This explanation would naturally occur to one.

As regards the curves and tortuosities, it may be assumed that they disappear with the growth in length of the body, for they do not exist in adults.

Luschka was probably the first to refer to spindle-shaped dilatations of the ureter in adults. He states (Anat. des Bauches, 1863, p. 204) that they occur in all cases.

Rauber and Quain state that the ureter is frequently enlarged near its lower end.

More recently Schwalbe (Verhandl. d. Anatom. Gesellsch. zu Berlin, 1896. Jena, 1896) describes as normal a fusiform dilatation of the ureter just above the pelvic brim and gives as a reason for its existence the angulation which is present here, which interferes with the flow of urine.

The ureter, according to this writer, has a pars abdominalis and a pars pelvina.

In quadrupeds in which there is no angulation (flexura marginalis, Schwalbe) and no pars pelvina, there are no dilatations. Schwalbe ascribes the angulation to the erect posture of man.

He found the spindles also in two fetuses and three newborn children, and decides that these peculiarities are inherited, and are not the result of individual development. SPINDLE-SHAPED DILATATIONS. — 127

Solger refers to these dilatations (Klin. Handbuch. d. Harn. und Sexual Organe, Leipzig, 1894, Bd. I.).

He also describes them in six fetuses and alludes to the tortuosities of the ureter (Anatom. Anzeiger., Bd. XII, Pp. 347).

It seems possible that these tortuosities might, in some cases, favor the development of hydronephrosis.