A correct diagnosis, it has been frequently remarked, is often sufficient to relieve the patient's mind, and secondarily her body, and may be all that is necessary in cases where the symptoms are all psychical and have arisen from the discovery of a tumor of unknown nature.
As a relief from the more serious annoyances the avoidance of certain disturbing causes may be of value, and such will consist in a proper regulation of the bowels and consequent avoidance of straining, and the choice of an occupation as little laborious and involving as little work in the upright posture as possible. No tight, narrow girdle should be worn about the upper part of the abdomen.
On the other hand, the use of a tight bandage over the whole abdomen is usually recommended, and seems to be useful in a small proportion of cases. It can of course act only by rendering the whole abdomen a little more tightly packed, and cannot exercise much restraint on any special portion of its contents. Pads of various shapes worn under the bandage may bring a little more local pressure to bear. One shaped like a carpenter's square, with an ascending branch to check the lateral movements, and a horizontal one to prevent the descent of the tumor, has been proposed. A truss with pads adapted to the loins and a front pad over the kidney has also been used.
It is impossible to read the history of many cases of this affection without becoming convinced that while the majority need but the mental assurance of the harmlessness of the tumor to restore their mental equilibrium, and others find their troubles bearable or capable of relief by mechanical appliances, no inconsiderable number are incapacitated from labor and the enjoyment of life by the necessity for great care in their movements, or suffer from severe symptoms, as pain and dyspepsia, which demand a more active treatment.
This has been afforded by operative surgery in two ways. Of these the most obvious is removal of the offending organ. It has now been clearly shown, by the number of nephrectomies that have been performed, that one healthy kidney is sufficient to support the function of urinary elimination; and if one kidney can be clearly shown to be healthy, the other can be safely removed. Such an operation undoubtedly adds to a patient's risks, since any subsequent renal affection is likely to prove fatal; but it has been now done a considerable number of times for the relief of the affection in question, and with good results. R. P. Harris5 has collected 16 cases with 10 recoveries, the organ removed in 3 out of the 6 fatal cases being diseased. Only 2 of these operations were by the lumbar incision, both being saved. They have since been reported.
5 Am. Journ. Med. Sci., July, 1882.
The operation has usually been done by the abdominal incision, which offers the advantages of greater accessibility of the pedicle for the purpose of ligating the arteries, and also greater ease in getting at the kidney itself, since it has often formed a partly separate pouch in the peritoneum, from which it would not be so easy to dislodge it by the lumbar incision. The latter operation is, as just stated, by no means impracticable nor specially dangerous. Of course it is desirable to avoid for some time after the operation anything which, like the use of diuretics or the excessive secretion of water, will throw any increased work upon the remaining kidney until it has had time to accommodate itself to them.
A singular case of attempted excision of a tumor supposed to be a wandering kidney, which could not be found after the incision was made, is recorded.6 In this case the symptoms, which, as well as the physical signs, had pointed distinctly to a movable kidney, disappeared after the operation. The author compares this case to another, in which great relief was experienced from a pretended operation for the removal of normal ovaries.
6 Hygeia, 11, 12, 1880, Svensson.