By WILLIAM E. LOWER, M. D., Cleveland Fellow of the American College of Surgeons. The occasions when transplantation of the ureters seems advisable do not occur very often, but they arise a sufficient number of times so that everyone doing genito-urinary surgery should acquaint himself with the best methods which have thus far been devised for accomplishing this result. Transplantation of the ureters may be advised in the following cases: (1) Cases of tumor of the bladder, so extensive that removal of the growth from within the bladder is impossible, which because of the constant flow of urine over the ulcerated areas produces such great discomfort that the patient's existence is almost intolerable; (2) cases in which a more radical operation, like cystectomy, should be done; (3) cases of exstrophy of the bladder; (4) cases of traumatic injury to the ureter, often at time of surgical operation upon the pelvic organs; and (5) cases of vesico-vaginal fistula, which follow removal of malignant growths of the uterus and which cannot be closed. The anatomic structures to which ureters are generally transplanted are the skin, either of the loin or of the groin, and some part of the intestinal tract, usually the sigmoid or the rectum. If the ureters are transplanted into the skin, it is necessary to make use of some urinary receptacle to catch the urine. While this is not an unsurmountable difficulty, nevertheless a considerable amount of personal attention is required to keep the patient comfortable. A very serviceable device, suggested by Peterkin, of Seattle, is shown in the illustration. The best place, probably, *Given before the Pathological Section of the Cleveland Academy of Medicine, November 3, 1916. Urinary receptable devised by Peterkin, for cases of transplantation of the ureters into the loin. (Reproduced with permission of Surgery, Gynecology and Obstetrics.) to transplant into the skin is at the loin, because a firm-fitting belt can be placed around the body, making the pressure on the rubber rings about the ureters sufficient to obviate any leakage of urine over the skin. The transplantation of the ureters into the rectum carries with it the danger of an ascending infection, but this, I think, |