Definition.—Pus in the urine.
Etiology.—Pus may arise from an abnormal condition of some part of the urinary tract, or it may break into it at any point and be discharged with the urine.
Pyelitis and Pyelo-Nephritis.—Calculi, tuberculosis, or other sources of irritation may give rise to inflammation of the pelvis, pus flowing with transitional epithelium. Where the pus is due to an abscess, it may be intermittent, days or weeks intervening, when the urine is free. When due to a calculus or tuberculosis, it is usually constant. In these cases the mixture of urine and pus is acid, but where the pyelitis and pyelo-nephritis follow cystitis, the urine is alkaline, contains more or less mucus, and is thick and gelatinous. In such cases the symptoms of bladder trouble are generally pronounced.
Cystitis.—When due to cystitis, the pus is peculiarly offensive, is thick, stringy, tenacious, contains mucus, and is alkaline in reaction. The pus and urine are so thoroughly mixed, that, when due to pyelo-nephritis, the triple phosphates are frequently present. The stringy mucus generally passes with the last portion of the urine.
Urethritis.—When due to urethritis, there is generally the history of gonorrhea, the quantity is small and passes ahead of the urine.
Leucorrhea.—As in gonorrhea, the quantity is usually small and mixed with large flakes of vaginal epithelium. Where there is any doubt as to the source, the urine should be drawn with a catheter.
Rupture of Abscesses info the Urinary Passages.—In these cases there are generally symptoms of an abscess at some part, either in the kidney or right iliac fossa—suppurative appendicitis. This form is usually accompanied by a sudden discharge of a large quantity of pus in the urine. It may be but for a short time and disappears as suddenly as it came, or gradually grows less, several days passing before there is a complete subsidence of pus.
Diagnosis.—We diagnose pus in the urine by the greenish, yellow, or yellowish-white tinge, the thick, ropy, tenacious character of the urine due to mucus, the ammoniacal odor, and generally alkaline reaction; by the presence of pus corpuscles, or leukocytes, as determined by the microscope. Phosphatic urine somewhat resembles pus in the urine, though in such cases the sediment is more white and the microscope at once reveals the difference.
Potassium-Hydroxid Test.—"Permit the urine to settle. Decant the clear liquid, and add to the sediment a solution of potassium hydroxid-caustic potash. If pus be present, a gelatinous mass results; if pus is found in the sediment, albumin may be expected in the clear liquid previously decanted."
Treatment.—This will depend somewhat upon the location of the pus-producing part. Thus, if of the bladder or urethra, the treatment will be quite different from abscess of the kidney.
We are to remember that pus in the kidney does not materially differ from pus in any other organ, and the remedies used for pus in the urine will be the same as those for suppurative processes wherever found,—such remedies as calcium sulphide, echinacea, baptisia, sodium sulphate, potassium chlorate, and the mineral acids as they may be severally indicated. The bowels should be kept soluble, with an occasional hydragogue cathartic, to flush the system and rest the kidney. The skin should be kept moist with an occasional dose of jaborandi or pilocarpin. Uva ursi, either tincture or infusion, will be found to give good results, and should be taken freely and continued for a long time.
The diet should be nourishing, easily digested, and fluids should be restricted to the smallest amount compatible with health.
If the pyuria be due to cystitis, irrigation of the bladder with a boracic acid solution or a weak solution of potassium chlorate with phosphate of hydrastin, should be used. Specific agrimony, elaterium, cantharidis, red onion, cockleburr, triticum repens, verbascum, chimaphila, and helonias are indigenous remedies, and will prove of great benefit.