Trans-Uretero-Ureteral Anastomosis

I. History of Ureteral Anastomosis.-One of the earliest operations, if not actually the pioneer case of ureteral anasto¬ mosis, was made by Simon, of St. Thomas' Hospital, London, in 1851, in an effort to extraperitoneally anastomose the ureters into the rectum.Nussbauni followed the method of Simon in 1876; also Smith in 1879.Most of the early attempts were made for the relief of vesical extrophy.Gluck and Zeller were among the early experimenters on animals.In 1886 Schopf,23 24 a German, and Poggi,30 an Italian, within a few days of each other performed an end-to-end anastomosis, though by different methods.Much experimentation on ani¬ mals now developed in the years following this notable ad¬ vance.Budinger in 1896 endeavored, on animals, to duplicate previous work, but with fatal results.Tizzoni and Poggi re¬ moved the entire bladder; a new receptacle was formed from an intestinal loop, and the ureters were implanted therein.In 1892 the technique of Van Hook was published.In 1897 Bovee, in reporting a personal case, collected 12 cases of ure¬ teral anastomosis from the literature, two of which must how¬ ever be discarded.He materially modified the method of Van Hook.The following method classification of uretero-ureteral anastomosis, together with exponents of each method, tabu¬ lated by Markoe and Wood23 is excellent: ( (a) Without support.Schopf, Hoch-I.Transverse end-to-end.-) enegg, Cushing.( (6) With support, Tauffer.687 Plate I.-Various methods of ureteral anastomosis, with their advocates.** Dr. Mills has here portrayed certain steps and the end results of actual anastomoses of the human ureter made by him for this plate.It is probable that, even with the reduction necessary to make a full-page plate of the Annals of Surgery, the dimensions will remain slightly in excess of the normal ureter.