The Suprarenal Capsules are situated at the upper extremities of the kidneys, and also extend along the inner border, the right being pyramidal and the left crescentic in shape. The right is moulded against the inferior vena cava, and the left is close to the aorta. In Addison s disease these capsules, which are closely connected with the solar plexus, are generally affected. Addison's disease is characterized by a bronzing of the skin, and pigmentation of the skin is also sden in pregnancy, abdominal tuberculosis, some affections of the liver, and carcinoma of the stomach, due probably likewise to some disturbance of the plexus.
The ureter commences in the dilated renal pelvis, which is connected to the medullary portion by the calyces or infundi-bula. Lying at first in the retroperitoneal tissue of the abdomen, it descends to the pelvic brim, which it crosses at the sacro-iliac articulation, to enter the pelvis. About 1 foot long, and possessing a strong muscular wall, the ureter is described in abdominal and pelvic portions. The abdominal portion is related in front and to either side to the peritoneum, colic and spermatic vessels, and on the right side to the termination of the ileum, and on the left to jejunum and pelvic colon. On the left side it lies immediately behind the inter-sigmoid fossa, as it crosses the common iliac artery. Behind, the ureters lie on the psoas sheath and genito-crural nerve, while internally the right ureter is close to the inferior vena cava, and the left to the aorta and inferior mesenteric vessels.
Septic infection frequently travels by the ureter from the bladder to the kidney, while, on the other hand, pus or blood coming from the kidney passes down the ureter to the bladder, where it may be seen, on cystoscopic examination, discharging from the mouth of the ureter, and the side of the affected kidney thus decided with certainty. A ureter catheter is sometimes introduced, with the object of obtaining a specimen of urine from one kidney.
Calculi not infrequently pass down the ureter from the kidney, generally causing severe renal colic, with sickness, vomiting, and retraction of the testicle, and sometimes they may become impacted in the ureter, causing hydronephrosis if neglected. In cases of obstruction of the urethra, urine may accumulate in the ureters and pelves, causing distension.
The ureter is not often wounded in the abdominal segment, but is in greater danger in the pelvic portion, where it has been wounded through the great sciatic foramen in deep gluteal wounds, while it also lies in the female in close relationship to the uterus, and is liable to damage in removal of the uterus in cases of extensive carcinoma. Where the bladder is also extensively involved, the ureters have sometimes been intentionally cut, and their ends implanted into either the vagina or the rectum. Rupture of the ureter has also occurred from external violence.