Ligature of the Renal Vessels by the Transperitoneal Method for the Cure of Persistent Urinary Renal Fistula: With Notes of One Successful Case.

(1) Choice of Procedure: (a) Nephrectomy.-In the absence of well-known contra-indications, nephrectomy is commonly acknowledged to be a legitimate surgical procedure in certain of these cases. But where there is extensive matting of the kidney and perinephritic tissues to surrounding structures, nephrectomy may be extremely difficult, or even impossible. The severity of the operation, the risk to the patient from hremorrhage, shock, and damage to important organs and serous cavities, justify the authoritative admission that the maintenance of good drainage is then the sole resource, in the vague hope that at some future and quite uncertain date healing may occur. (b) Subcapsular Nephrectomy; (c) Morcellement.-In other cases subcapsular nephrectomy, piecemeal nephrectomy or morcellement· may be tried, but these operations are often followed by prolonged suppuration or by permanent fistula, owing to a portion of renal tissue having been left behind, as it frequently i&. (2) Disabilities attendant on a Persistent Renal Sinus.-Taking the case of a young and otherwise robust man, who has to earri!his