THE URINARY ORGANS 253 



bladder is distended, the operator can, if he prefers it, open 

 the abdomen in the male immediately in front of the ex- 

 tremity of the prepuce. The advantage of this is that there 

 is less haemorrhage, as there is practically no muscle tissue 

 to cut through. 



The bladder is exposed and brought through the incision 

 on to a piece of boiled lint, jaconet, mackintosh, or some 

 such material, and the lower part tightly packed. The 

 rupture is sought for and sutured (Lembert's pattern) with silk 

 (see p. 55), the abdomen very carefully swabbed out \\ith 

 some antiseptic solution, and the wound of the abdominal 

 wall covered with iodoform colloid, etc., as already described 

 (p. 50). 



Tumours of the Bladder. 



Of these, the most commonh' met with are papilloma, 

 sarcoma, and carcinoma. Others are m\'xoma and fibroma. 

 They may occur outside the bladder, and ha\'e adhesions 

 or connections with surrounding structures, or be found 

 inside, growing on the mucous membrane. In the latter 

 case, after a certain time has elapsed, the\' ha\'e a villous or 

 fungoid appearance, and bleed on the slightest touch. 



Svinptonis. — In the earl}- stage the onl\- s\-mptom noticed 

 is hsematuria, the urine being blood-stained. This is presentl)- 

 followed by pain whent\er urine is passed, the bladder 

 being irritable, and the act of urination more frequent. In 

 the last stages the patient becomes emaciated through pain 

 and \\'ant of rest, and the urine may be fcetid or purulent. 



Diagnosis is aided by the use of a sound (Fig. 156) or 

 catheter, the tumour (if sufficiently large) being felt as a soft, 

 spongy body resisting the progress of the sound inside the 

 bladder. If small, howe\'er, this cannot be detected. A 

 rectal examination should alwa}'s be made. 



Treatment. — Before resorting to surgical aid medicinal 

 remedies maj' be tried. The bladder should be washed out 

 with a solution of non-irritating antiseptic, such as adrenalin, 



