THE GENESIS AND DEVELOPMENTAL PROCESS OF URETERITIS TUBERCULOSA

Abstract

Histopathological studies were made on the genesis and developmental process of ureteritis tuberculosa by means of serial sections made of ureters taken from fifteen specimens of surgically removed tuberculous kidneys at an early primary stage. The results were as follows;
1) It was found that already at an early period of development of tuberculosis in the kidney, pathological changes due to tuberculosis have tendency to spread rapidly along the entire length of the ureteral wall. It was also evident that the extension of the tuberculous process follows the vascular system in addition to the urinary passage and the lymphsystem as already known.
2) It is extremly rare to find the extension from the kidney along the lymphatics in the narrow sense.
3) It is difficult to obtain histological pictures which actually demonstrate the infection acompanied by pathological changes spreading through the mucous membrane of the ureter.
4) The tuberculous changes of the ureter affect the submucosa, the muscularis and the adventitia, regardless of the desquamation and ulceration of the mucous membrane.
5) Pathological changes in the submucosa, in the muscularies and in the adventitia are characterized often by swelling and hyperplasia of the lining cells of the capillaries and smaller artiries and veins, by tubercle formation and by infiltration of small round cells.
6) Even in cases where pathological changes are abscent in the mucous membrane, pathological changes are always found around the blood vessels in the submucosa, in the muscularis and in the adventitia.
7) Studies were also made on the distribution of the tubercle bacilli an the genesis and developmental process of ureteritis tuberculosa by means of the fluorescent microscopical apparatus adapted for the purpose of the detection of the bacilli in the ureteral tissue.
8) In tuberculosis of the ureter, 90 per cent of the sites containing a large number of the bacilli, are the purulent materials in the ureter, the anter layer of the submucosa with necrotic ulceration, and the mucous slough. In 60 per cent of these a moderate number of the organisms are found in the dilated and regenerated areas around the capillaris in the submucous infiltration foci as well as in those where hemorrhage due to diapedesis has occurred.
Furthermore, the locations, 30 per cent of which containing less numbers of organisms, are in the areas of cellular infiltration containing epitheloid cells in the muscularis and adventitia of the blood vessels where tubercle formation has occurred. In a few instances, the tubercle bacilli were also demonstrated within the lumina of blood vessels. All of these findings are regarded as furmishing important evidence in favor of the hematogenous dissemination of the tuberculous process.
9) In 14 cases (100 per cent) of X-ray photographs of the ureter, pathological enlargement of the organ on the affected side was found.
The cause of the enlargement is considered as partly a reduction of muscular contraction due to atrophy of the muscularis or cellular infiltrations.