URETHROTOMY. LITHOTOMY. 91 



the rectum. One must avoid grasping, along with the stone, 

 the mucous membrane of the bladder. Partial rilling of the 

 bladder with a tepid aseptic solution will aid in grasping the 

 calculus and in avoiding the implication of the bladder walls. 

 By careful rotary movement and pushing the forceps back- 

 ward and forward the operator can determine before the ex- 

 traction of the stone if the forceps can be withdrawn easily 

 and without much resistance through the neck of the 



FIG. 8. Urethrotomy at the ischial notch. 



bladder. If the stone is so large that it can not pass the 

 neck of the bladder lithotripsy must be performed. This 

 operation requires time and patience, since as a rule it is not 

 possible to encompass the entire calculus with the forceps. 

 That is, the narrowness of the neck of the bladder prevents 

 the sufficiently wide opening of the forceps. The stone con- 

 sequently must be gradually broken off at its periphery and 

 the individual pieces of calculus removed. The character of 

 the surface of the stone has an evident bearing upon the 

 practicability of lithotripsy. 



When this operation is impossible, the operative dilation 



