X-ray Examination of the Urinary Tract.

WITH the gradual improvement in radiological technique during the past twenty years, X-ray examination has assumed a greater importance in the diagnosis of disease of the urinary tract than almost any other ancillary method. Indeed, no investigation of the urinary tract from the surgical aspect can be regarded as complete without X-ray examination. In many cases the diagnosis is settled by that means, and in others the field of possibilities narrowed by exclusion, say, of calculus, hydronephrosis, &c. Preparation of the Patient.-This is of some importance. It is desirable that the patient's alimentary canal be as empty as possible; both fluid, faecal and gaseous contents may obscure the radiographic picture. With modern technique, in which great contrast is the desideratum, any considerable collection of gas in the colon might literally " black out" the renal areas in the negative. The routine preparation is as follows : (I) An aperient on the day before. Salines should not be used, because of their composition and tendency to cause gaseous distension. Castor oil is probably the most satisfactory. (2) On the day of the examination an enema may be given, if the result of the aperient has not been satisfactory. As little food as possible should be taken, the quality being unimportant. (3) The bladder should be emptied immediately before the examination. Technique.-In general, screen examination is of no value. As a routine, radiograms should be taken to include the whole tract. A low kilovoltage, in the region of 70 kv. peak, double screens, and the Bucky grid are essential points in the production of radiograms of the necessary quality.