622 



VESICAL CALCULUS. 



opening is enlarged with the probe-pointed knife inserted in the 

 groove of the staff. Having opened the urethra, the staff may be 

 withdrawn a few inches while the bladder is irrigated with a warm 

 solution of boracic acid introduced by means of a Higginson's syringe. 

 At this stage, if uncertainty exist as to whether or not the calculus 

 is free, or fixed in the mucous membrane, the steel sound passed into 

 the bladder and carefully manipulated will be found helpful. If 

 the calculus is free, the forceps (Fig. 430) are now passed into the 

 bladder, and attempts made to grasp the stone. As soon as contact 

 with it is felt or heard, the forceps are opened and 

 an effort made to seize the stone. The bladder 

 being empty and more or less contracted, its wall 

 is closely applied to the calculus and the forceps 

 in closing are apt to engage a portion of the 

 mucous membrane. A hand in the rectum is of 

 much assistance in guiding the stone into the jaws 

 of the forceps. Once grasped, the stone is held 

 lightly, while the forceps are slowly rotated or 

 gently pulled to make sure that the mucous mem- 

 brane has not been included ; and if no resistance 

 is felt the forceps are firmly closed on the stone, 

 which is drawn forward and removed. 



In extracting the calculus the forceps should 

 be half rotated, occasionally pulled laterally, and 

 as progress is made pulled steadily towards the 

 perineum. 



The steel sound should be reinserted, or the 

 bladder may be examined from the rectum, to 

 make certain that no fragment, other calculus, or 

 gravel is present, which would require removal or 

 washing out, otherwise the bladder is again irrigated 

 with warm boracic solution. 

 Suturing the wound is not absolutely necessary, though it some- 

 what hastens recovery ; but if unskilfully performed, so that the 

 urethra is left open while the skin is closed, infiltration of urine 

 occurs and leads to abscess formation. For a short time urine 

 escapes in part by the operation wound; but this soon closes, and 

 only occasionally does urethral fistula result. 



After-treatment consists in washing out the bladder occasionally 

 with a lukewarm solution of boric acid or a 3 per cent, solution 

 of protargol, by means of a rubber tube. If treatment must be 

 left to laymen, a tube may be fixed in the urethra, otherwise 



Fiu. 430. 

 Calculus forceps. 



