Definition:—A condition in which the urine, when passed, contains pus.
Etiology:—Inflammatory disease of the structures of the urinary tract, especially that of a chronic character, may result in the formation of pus, which may be excreted through the urine. Abscesses forming in the adjacent structures may discharge pus into the urinary tract.
Symptomatology:—A chronic catarrhal condition of the lining of the kidneys is known as pyelitis. If the structure of the kidney itself be involved, which is indicated by the presence of casts in the urine, this induces a condition known as pyelonephritis. In either case there may be a complication from the presence of a calculus or from tuberculosis, which causes the disease to become chronic and which materially interferes with a permanent cure. Occasionally an abscess may form in some part of the kidney structure which opens into the pelvis, and through this there may be a more or less continuous discharge of pus. While this does not necessarily induce disease in the mucous lining of the pelvis, it is very apt to do so. This condition usually involves only one kidney, although it is not impossible that both kidneys may be similarly affected.
Pyuria sometimes occurs as the result of inflammation of the bladder, which extends upward through the ureter to one or both of the kidneys. This is especially likely to be the case when cystic inflammation results from gonorrheal infection. The urine is alkaline in reaction in this disease, usually has a low specific gravity, is free in quantity, but contains a heavy, white, gelatinous sediment. Occasionally, when there is some ulceration present, blood will be found mixed with the pus. When the inflammation is located in the bladder walls alone, the same conditions obtain, as far as the appearance of the urine is concerned, as in the above named case, but there is apt to be more of a separation between the pus and the urine, and a quite distinctive feature is the presence of mucus in the urine, sometimes in large quantity, or muco-pus, stringy and tenacious in character and quite offensive. The urine is alkaline and often very irritating to the urthera when passed.
Catheterization of the ureters will determine that the urine flows clear from the kidneys. When the pus is formed in the urethra alone, there will be tenderness on pressure, pain in the passage of urine, and some obstruction to the flow of the urine at the start, when it will be found that a quantity of pus has passed in advance of the urine. This condition seldom occurs except as a result of gonorrhea.
When pyuria occurs from the rupture of a contiguous abscess into the urinary passages, there will have been no previous history of the presence of pus in the urine, in the acute cases, and the pus will appear abruptly. After being present for a few hours, or perhaps from one to two days, it may disappear as abruptly as it came. In other cases it may decrease gradually for two or three days before its entire disappearance. There will be a history of other inflammatory disease or there will be found an area of tenderness in conjunction with some of the contiguous organs which will lead to the suspicion of an inflammation and a tendency toward pus formation.
Diagnosis:—The presence of a clear, white sediment in urine which has been previously cloudy will point to pus. The examination of a small quantity under a low-power glass will show the large, somewhat rough, irregularly shaped cells. Both phosphaturia and oxaluria will present a white sediment, but these can be distinguished by microscopical or proper chemical examination. A quick test of urine for pus can be made by means of a solution of potassium hydrate; the ordinary liquor potassse will be sufficient. If a quantity of this be added to the sediment from which the clear urine has been decanted, a gelatinous mass will result. As pus serum contains albumin, urine containing pus will therefore always contain albumin, which is with difficulty distinguished from albumin of albuminuria.
Treatment:—I have obtained excellent results in the treatment of this condition by the use of the tincture of the chlorid of iron. There are many indications that point to its use. One of my patients, a very severe case, received no benefit from any treatment until he stopped the use of tobacco, when the pus ceased rather abruptly. After two years it returned immediately he began to smoke, and stopped again when the tobacco was finally discontinued permanently. The use of echinacea with hydrastis canadensis, or the two remedies with hamamelis, continued for a long period, will correct the condition. Good results will follow the use of triticum, epigea repens, marshmallows or hamamelis. If the pus is mixed with blood, I should give the indicated remedy in conjunction with gallic acid or thuja.
In cases of purulent cystitis, an occasional irrigation of the bladder, conducted with extreme care as to asepsis, will be necessary at the onset. Later, irrigation should be avoided, except when imperative. A solution of boric acid, or a few drops of extract of pinus canadensis, or hydrastis, or a distilled extract of witch hazel may be used. I have obtained the best of results in those cases where the urine has a fetid, acrid smell and an alkaline reaction, from the use of benzoic acid four grains, sodium borate six grains, in half an ounce of cinnamon water, given every two hours. The results from this are immediate relief from pain and tenesmus, an increase in the flow of the watery portion of the urine, a marked decrease in the quantity of pus and mucus and a satisfactory abatement of the symptoms. If one dram of thuja be added to three drams of chimaphila, this mixture may be given in doses of fifteen drops every two hours in a tablespoonful of cinnamon water, with fine results. Elaterium in small doses is suggested when there is teasing, irritating tenesmus. Ten drops of the specific medicine are added to four ounces of water and given in teaspoonful doses every two hours. Specific cocklebur and specific red onion are indicated by irritation from the presence of sand or gravel in the sediment, with a constant or frequent desire to urinate. Much attention should be paid to diet with these patients. It should be bland, non-irritating and readily digestible.