CASE HISTORY

The patient suffered from coronary atheroma and finally died of coronary thrombosis, and most of his clinical notes related to his heart. One year before death he was admitted to the surgical wards on account of haematuria. On cystoscopy a sessile papilloma was found on the left wall of the bladder close to the ureteric orifice. This was destroyed by a trans-urethral electro-coagulation. This tumour was presumably a local recurrence as there was a history of a suprapubic removal of a bladder tumour four years previously at another hospital. After the second operation he was discharged and remained free from any urinary symptoms until death.

PATHOLOGY

The specimen consists of the posterior half of the left kidney, the bladder and the greater part of the left ureter. The bladder has been opened eccentrically but the position of the right ureter is marked by a bristle. On the left wall of the bladder in the region of the ureteric orifice there is a radiating fibrous scar which appears to be completely obstructing the urinary flow since at autopsy no connection could be made out between the ureter and the bladder. The ureter is widely dilated and its wall thickened and hypertrophied. Just above its entry to the bladder the ureter is kinked and scarred. This scar may be due to the passage of a stone as one was found in the bladder at autopsy. The dilation extends up the whole length of the ureter. The kidney shows typical hydronephrosis. The pelvis is dilated as also are the calyces. The kidney parenchyma has been stretched so as to form a narrow rind. This appears to be slightly fibrosed but shows no signs of infection.