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Stricture of the ureter is also a very rare occurrence except as a result of compression of abdominal or pelvic new growths。 Watson has； however； reported two cases of stricture； in both of which a ureter was nearly or quite obliterated by a dense mass of connective tissue。 In one case there was a history of the passage of a renal calculus years previously。 In both instances the condition was associated with pyonephrosis。 Watson has collected the reports of four other cases from medical literature。
A remarkable procedure recently developed by gynecologists； particularly by Kelly of Baltimore； is catheterization and sounding of the ureters。 McClellan records a case of penetration of the ureter by the careless use of a catheter。
Injuries of the Bladder。Rupture of the bladder may result from violence without any external wound （such as a fall or kick） applied to the abdomen。 Jones reports a fatal case of rupture of the bladder by a horse falling on its rider。 In this case there was but little extravasation of urine； as the vesical aperture was closed by omentum and bowel。 Assmuth reports two cases of rupture of the bladder from muscular action。 Morris cites the history of a case in which the bladder was twice ruptured： the first time by an injury； and the second time by the giving way of the cicatrix。 The patient was a man of thirty…six who received a blow in the abdomen during a fight in a public house on June 6； 1879。 At the hospital his condition was diagnosed and treated expectantly； but he recovered perfectly and left the hospital July 10； 1879。 He was readmitted on August 4； 1886； over seven years later； with symptoms of rupture of the bladder； and died on the 6th。 The postmortem showed a cicatrix of the bladder which had given way and caused the patient's death。
Rupture of the bladder is only likely to happen when the organ is distended； as when empty it sinks behind the pubic arch and is thus protected from external injury。 The rupture usually occurs on the posterior wall； involving the peritoneal coat and allowing extravasation of urine into the peritoneal cavity； a condition that is almost inevitably fatal unless an operation is performed。 Bartels collected the data of 98 such cases； only four recovering。 When the rent is confined to the anterior wall of the bladder the urine escapes into the pelvic tissues； and the prognosis is much more favorable。 Bartels collected 54 such cases； 12 terminating favorably。 When celiotomy is performed for ruptured bladder； in a manner suggested by the elder Gross； the mortality is much less。 Ashhurst collected the reports of 28 cases thus treated； ten of which recovereda mortality of 64。2 per cent。 Ashhurst remarks that he has seen an extraperitoneal rupture of the anterior wall of the bladder caused by improper use of instruments； in the case of retention of urine due to the presence of a tight urethral stricture。
There are a few cases on record in which the bladder has been ruptured by distention from the accumulation of urine； but the accident is a rare one； the urethra generally giving way first。 Coats reports two cases of uncomplicated rupture of the bladder。 In neither case was a history of injury obtainable。 The first patient was a maniac； the second had been intoxicated previous to his admission to the hospital； with symptoms of acute peritonitis。 The diagnosis was not made。 The first patient died in five days and the second in two days after the onset of the illness。 At the autopsies the rent was found to be in both instances in the posterior wall of the bladder a short distance from the fundus； the peritoneum was not inflamed； and there was absolutely no inflammatory reaction in the vesical wound。 From the statistics of Ferraton and Rivington it seems that rupture of the bladder is more common in intoxicated persons than in othersa fact that is probably explained by a tendency to over…distention of the bladder which alcoholic liquors bring about。 The liquor imbibed increases the amount of urine； and the state of blunted consciousness makes the call to empty the bladder less appreciated。 The intoxicated person is also liable to falls； and is not so likely to protect himself in falling as a sober person。
Gunshot Wounds of the Bladder。Jackson relates the remarkable recovery of a private in the 17th Tennessee Regiment who was shot in the pelvis at the battle of Mill Springs or Fishing Creek； Ky。 He was left supposedly mortally wounded on the field； but was eventually picked up； and before receiving any treatment hauled 164 miles； over mountainous roads in the midst of winter and in a wagon without springs。 His urine and excretions passed out
through the wounds for several weeks and several pieces of bone came away。 The two openings eventually healed； but for twenty…two months he passed pieces of bone by the natural channels。
Eve records the case of a private in the Fifth Tennessee Cavalry who was shot in the right gluteal region； the bullet penetrating the bladder and making its exit through the pubis。 He rode 30 miles； during which the urine passed through the wound。 Urine was afterward voided through the left pubic opening； and spicules of bone were discharged for two years afterward； ultimate recovery ensued。
Barkesdale relates the history of the case of a Confederate soldier who was shot at Fredericksburg in the median line of the body； 1 1/2 inches above the symphysis； the wound of exit being in the median line at the back； 1/2 inch lower down。 Urine escaped from both wounds and through the urethra。 There were no bad symptoms； and the wounds healed in four weeks。
The bladder is not always injured by penetration of the abdominal wall； but may be wounded by penetration through the anus or vagina； or even by an instrument entering the buttocks and passing through the smaller sacrosciatic notch。 Camper records the case of a sailor who fell from a mast and struck upon some fragments of wood； one of which entered the anus and penetrated the bladder； the result being a rectovesical fistula。 About a year later the man consulted Camper； who unsuccessfully attempted to extract the piece of wood； but by incising the fistula it was found that two calculi had formed about the wooden pieces； and when these were extracted the patient recovered。 Perrin gives the history of a man of forty who； while adjusting curtains； fell and struck an overturned chair； one of the chair…legs penetrated the anus。 Its extraction was followed by a gush of urine； and for several days the man suffered from incontinence of urine and feces。 By the tenth day he was passing urine from the urethra； and on the twenty…fifth day there was a complete cicatrix of the parts； fifteen days later he suffered from an attack of retention of urine lasting five days； this was completely relieved after the expulsion of a small piece of trouser…cloth which had been pushed into the bladder at the time of the accident。 Post reports the case of a young man who； in jumping over a broomstick； was impaled upon it； the stick entering the anus without causing any external wound； and penetrating the bladder； thus allowing the escape of urine through the anus。 A peculiar sequela was that the man suffered from a calc