Abstract
In studying the ureteral contractions by the electrical method as described by Paladini, 1 it occurred to us that the localization of ureteral pain could be studied by applying a stimulus to the electrode and having the patient describe the area in which the pain was felt. Experiments of this kind have been extensively done on the pleura, pericardium and peritoneum by Capps 2 and more recently by Boyden and Rigler 3 on the gastrointestinal tract.
Since the electrodes used in the contraction studies were not quite suitable for pain distribution studies, a special electrode with a single metal contact at the tip was manufactured for this purpose by the American Cystoscope Makers, Inc. A Harvard inductorium was used for the source of current with 6 volts on the primary circuit. The inactive electrode was applied to the chest.
The patient was cystoscoped, the ureteral catheter electrode was introduced into the ureter and stimulation was made at various levels up the ureter. The distance between stimulation points was 5 cm., since it was felt that too frequent stimulation led to indefinite and inaccurate interpretation. After the conclusion of the experiment pyeloureterograms were taken to exclude pathology in the urinary tract.
The results obtained in 8 patients so studied may be briefly summarized as follows:
In the lower one to 2 cm. of the ureter, the pain was referred suprapubically, being almost in the midline and extending upward about 4 cm. Pain into the perineum occurred in some cases but was not constant. Five centimeters from the ureteral orifice the pain was higher and somewhat lateral to the midline. The pain was always below the iliac crest and somewhat medial to McBurney's point.
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