Dr. Charles K. Jenkins: A 48-year-old white woman went to see her physician because of frequent and painful urination. Pyuria was found at that time, and sulfisoxazole, 1 gm/day, was given for a total of four months. The symptoms improved, but recurred one month later. Intravenous pyelography was performed at this time and was reported as abnormal. The patient was referred to this hospital.
Results of physical examination were essentially normal. Examination of the abdomen revealed no costovertebral angle tenderness and no mass or organic enlargement. Laboratory studies showed a blood urea nitrogen of 17 mg/100 cc and a serum creatinine value of 1.6 mg/100 cc. Urine showed 30 to 40 white blood cells per high-power field and 3+ bacteria. Urine culture grew Escherichia coli.
On cystoscopy the bladder appeared entirely normal. Although several attempts were made to introduce a No. 8 acorn-tipped catheter into the left ureter, it would