The routes by which infection may travel in reaching the ureter and kidney from the bladder are: (1) regurgitation of the contents of the bladder through the ureterovesical orifice, (2) direct extension through the wall of the ureter, (3) extension of the infection by way of the lymphatics and (4) by way of the blood stream.
From the clinical standpoint, Rovsing,1 Israel,2 Stoeckel,3 Albarran,4 Warschauer5 and others believed that a stagnating urinary column due to ureteral obstruction favored the upward spread of organisms.
Rovsing1 and Melchior6 concluded: (1) that experimental cystitis could not be produced in animals without retention of urine or trauma to the bladder; (2) that with retention of urine experimentally produced, pyelitis as a rule did not result, and (3) that trauma to the bladder with or without retention of urine produced pyelonephritis.
Zeit7 and Peterson,8 in 1899,
CARSON WJ. ASCENDING URINARY INFECTION: AN EXPERIMENTAL STUDY. Arch Surg. 1931;23(1):74–84. doi:10.1001/archsurg.1931.01160070077005
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