URETHROTOMY. LITHOTOMY 



95 



After the catheter has been drawn back away from the 

 ischial arch, introduce the lithotomy forceps into the urethra 

 or bladder, grasp the stone and draw it outward in its natural 

 direction. The grasping of the stone with the forceps is 

 materially aided by means of the left hand introduced into 

 the rectum. One must avoid grasping, along with the 

 stone, the mucous membrane of the bladder. Partial filling 



FIG. 40 



Urethrotomy (life size), h. Skin ; a, retractor penis muscle ; 

 b, bulbo-cavernosus muscle ; r, spongy urethra ; u, urethra ; 

 k, catheter. 



of the bladder with a tepid aseptic solution will aid in grasp- 

 ing the calculus and in avoiding the implication of the 

 bladder walls. By careful rotary movement and pushing 

 the forceps backward and forward, the operator can deter- 

 mine before traction is exerted if the forceps can be with- 

 drawn easily and without much resistance through the neck 

 of the bladder. 



If the stone is so large that it cannot pass the neck of the 

 bladder, lithotripsy may be performed. This operation re- 



