PUNCTURE OF THE BLADDER. 633 



which he incises the abdominal wall at the side of the sheath parallel with 

 the linea alba in the male, or through the white line in the female. The 

 incision extends from the umbilicus to near the os pubis. Haemorrhage 

 having been stopped and the peritoneum opened, the bladder is drawn 

 into the wound and fixed with a sterilised compress. An incision § to 1 inch 

 long is then made through the fundus or superior wall of the bladder, and 

 the calculus grasped with forceps is extracted. After washing out the 

 bladder with boracic solution, the wound is closed by Lembert's sutures, 

 or by superposed stitches. The suture line is mopped with alcohol or 

 strong solution of carbolic acid and the bladder is released. The abdominal 

 wound is sutured in layers, and finally the seam is dried and covered with 

 iodoform-collodion. Rubay claims to have opened the kidney without 

 penetrating the peritoneal sac, removed the calculi, and washed out the 

 pelvis of the kidney and returned the organ to its position. 



III.— PUNCTURE OF THE BLADDER (PUNCTIO VESICAE). 



When the discharge of urine by the natural passage is hindered, 

 the urinary bladder becomes enormously distended, and puncture 

 by trocar is resorted to to prevent rupture. The operation was 

 first practised in dysuria in man, and is still employed, particularly 

 in cases of enlargement of the prostate. The trocar used for the 

 horse is an enlarged copy of that constructed for the above purpose 

 by Flourant (Fig. 436). Pilger described the operation more exactly, 

 and later it was frequently employed in oxen which suffered from 

 urethral calculi. Before attempting it, the diagnosis of over-distended 

 bladder must be verified by rectal examination. In the horse the 

 distended bladder extends forwards and downwards, that is, towards 

 the abdominal cavity. In oxen and bulls the extension takes place 

 more towards the sides. Even in the horse, however, the bladder 

 does not reach the lower wall of the abdomen ; this condition is only 

 seen in swine and carnivora, in which the bladder, when filled, lies 

 to a great extent in the abdominal cavity. It need scarcely be said 

 that, before making the attempt, all simpler means, as, for instance, 

 the use of the catheter, should have been tried. 



The bladder may be reached from different points if Flourant's 

 form of trocar, which is moderately bent (Fig. 436), be employed. 

 Three different methods of puncture are distinguished. 



(1) Punctio vesicae suprapubica is impracticable in herbivora, 

 because in them the lower part of the bladder is not attached to 

 the wall of the abdomen, and in the horse and ox the bladder 

 would be only reached through the peritoneal cavity. In swine 

 and dogs it can, however, be approached from the lower abdominal 

 wall, and this path is to be preferred because the more convenient 

 method of operation through the rectum employed in larger animals 



