EXPERIMENTAL STUDY OF CHANGES IN THE RENAL CIRCULATION SUBSEQUENT TO THE URETERO-ENTEROSTOMY, BY MEANS OF THE INJECTION OF THE INDIAN INK

Abstract

Dogs used in this experiment (totalling fourty-six) were divided into two groups; The first group consisting of 13 dogs was subjected to the right-side uretero-sigmoidostomy (Coffey-I method), thereafter too the injection of the Indian ink into the abdominal aorta at various post-operative periods. The second group consisting of five dogs was subjected to occlusion of the right ureter aiming hydronephrosis of the operated side, thereafter to the injection of the Indian ink. Macroscopic and histological comparison of bilateral kidneys, one the operated, the other intact, were carried out and also that of the second group with the first.
Results of the experiment were following
1) In the first group in which the uretero-sigmoidostomy was done, the distributed amount of the Indian ink was smaller than expected normally up to the third day in bilateral kidneys irrespective of cortex and medulla without any deviation of renal circulation such as called “shunt”. Then it gradually increased to normal at about the seventh day in the operated side and at about the tenth day in the non-operated side. Thereafter, however, in the kidneys whose ureters were anastomosed, swelling of epithelial cells lining the tubules, dilatation of the tubular lumen and retention of the secretion, which began to be noticed already several days after the anastomoais, advanced further. Fourteenth day post-operatively hydronephrosis developed gradually, in parallel to which the amount of the. Indian ink in both cortex and medlla decreased again. This change became more remarkable toward the seventieth day when hydronephrotic atrophy was far advanced.
2) In the second group of the occlusion of the ureter histological signs of hydronephrosis appeared already at the fifth day paralleling to which the amount of the Indian ink distributed within the kidney decreased irrespective of cortex and medulla. This tendency became marked at about the tenth day when the hydronephrosis was recognized macroscopically. This finding corresponded to that seen at the fourteenth day in the first group in which uretero-sigmoidostomy was performed.
Following conclusions were drawn from the results of these experiments in consideration of a series of experiments done in our department in which clearance test and renal arteriography were carried out after the uretero-sigmoidostomy: Immediately after the uretero-sigmoidostomy transient decrease of renal blood flow was observed without vasospasm or deviation of the stream, which was considered to result directly from the affected ureter and from general condition of the body after operation. The decrease of renal blood flow which again became remarkable after the fourteenth day should not be considered characteristic of the uretero-intestinal anastomoais but resulting from a hydronephrotic change.