412 The Bladder 



centre is thrown out of working order, not only is the patient unaware 

 when the bladder is full, but no motor impulse is transmitted to the 

 muscular coat, and the bladder ' brims over.' 



Extreme retention of urine may exist without causing distress when 

 the patient has become gradually accustomed to it, but sudden accumu- 

 lation from tension of sensory nerves, causes great agony. Chronic 

 retention may be mistaken for abdominal ascites. Before tapping for 

 the latter condition it is, therefore, the rule to pass a catheter. The 

 over-loaded bladder may also be mistaken for ovarian disease or 

 pregnancy. The distended bladder may be ruptured from violence. 

 If the rent implicate the postero-lateral aspect, peritonitis is very 

 likely to follow. If the rent be at the front or base of the bladder 

 the escape will be extra-peritoneal, cellulitis and abscess probably 

 occurring. As a rule the urethra gives way rather than the bladder, 

 perineal abscess being the result. 



The chief signs of the intra-peritoneal rupture are inability to mic- 

 turate from the time of the injury ; onset of collapse on account of the 

 extravasation into the peritoneal cavity ; the bladder containing only 

 a little blood-stained urine whilst a long metal catheter may, perhaps, 

 pass through the rent until its beak is found behind the linea alba. 

 Lastly, warm water quietly injected into a ruptured bladder quickly 

 disappears. Abdominal section, suture of the wound, and flushings of 

 the peritoneum with a warm antiseptic solution, would be needed. 



When ascites has been mistaken for retention of urine, the catheter 

 being introduced and the bladder being found empty, the practitioner 

 has sometimes imagined that the instrument was not thrust in far 

 enough, and has thereupon driven the beak of the instrument through 

 the posterior wall of the bladder, which would in such circumstances 

 fall near to the trigone, and has thus evacuated the peritoneal cavity of 

 serum. 



In the case of an enormous calculus, or of villous disease, the bladder 

 may be opened above the pubes through an incision in the linea alba ; 

 but before performing this operation the bladder should be carefully 

 washed out and distended, and thrust bodily forwards and upwards 

 by the gentle inflation of an india-rubber bag in the rectum. Thus the 

 peritoneum is pushed high up and the bladder opened without difficulty 

 and without much danger. In the case of urgent cystitis from prostatic 

 enlargement a tube might be permanently worn above the pubes. 



Through an incision in the perineum the finger can usually be 

 made to explore the whole of the interior of the bladder, its summit 

 and anterior wall being pushed downwards by the hand upon the 

 abdominal wall. 



THE PROSTATE GLAND 



The prostate is a mixture of fibrous tissue, non-striated muscle, 

 and of follicular gland-tissue. It is placed in front of the bladder (71720, 



