THE EFFECT OF LIGATION OF THE INTERNAL ILIAC ARTERIES UPON THE LOWER URETER

Abstract

Controversy continued as to whether ligation of the internal iliac arteries can result in ischaemic necrosis of the lower ureter. In order to elucidate this point of dispute,
1) The superior vesical arteries of the rabbit were ligated and its ureter was histologically studied from next day through the 350th day after the operation. As a result, no particular abnormalities were demonstrated in the ureteral wall in general except for slight vacuolization of the ureteral epithelial cells and thinning of the muscular layer, and ischaemic necrosis was found in none of the cases.
2) Twenty-eight cases of recurrence of papillary bladder tumor and three cases of re-operation after prostatectomy were subjected to ligation of the bilateral internal iliac arteries. The IVP, cystogram and indigocarmin test performed on these cases proved improvement of the pre-operation conditions in most of them. Part of this success may be attributed to the excision of the papillary bladder tumor concurrently conducted. In none of the cases developed urinary fistula.
From the facts cited above, it was speculated that, if the vessel network surrounding the lower ureter is not injured, supplementary circulation comes to be established and ischaemic necrosis does not take place.