OPERATIONS ON THE KIDNEY. I 19 



mends that the wound be left open. The catheter should be 

 passed right into the bladder to make sure that the passage is 

 clear, as the presence x>{ a small stone in the urethra usuallj^ 

 indicates that there are others higher up; on two occasions 

 we have counted more than fifty small calculi in urethra and 

 bladder. In some cases it is a wise plan to leave the canula 

 of the catheter m situ for some hours after the operation. The 

 wound itself is treated with antiseptics in the usual manner. 



The prognosis of these cases must always be guarded, 

 especially where the patient has been left until almost in a 

 state of collapse before surgical aid is attempted. 



In the female the shorter urethral canal does not offer quite 

 so many difficulties. A calculus lodged in it can sometimes 

 be grasped and crushed or withdrawn by a pair of fine forceps, 

 or if necessary a fine blunt pointed tenotome or Paget knife 

 may be used to enlarge the orifice. Material assistance in 

 removing calculi from the urethra of the bitch can often be 

 obtained by manipulation with the finger through the rectum. 



Operations for Renal Calculus, Nephro-Lithotomy, Neph- 

 rectomy. — Although calculi of the kidney are by no means 

 common, they are not infrequently met with by those who 

 have a large number of canine patients to deal with. As a 

 general rule, they are not diagnosed until the post-mortem 

 examination is made, and it is the difficulty of making a 

 certain diagnosis which is at present so hard to overcome. 



By the term " nephro-lithotomy " is indicated the operation 

 of cutting into the kidney in order to remove a stone. A 

 laparotomy is performed in the usual way in the flank on the 

 side suspected to be affected, and the kidney is exposed to 

 view. As a rule, the calculus is situated in the pelvis. An 

 incision is made directly down on to it, it is removed, and the 

 wound is drawn together with fine sutures. The peritoneal 

 wound is treated in the usual way. 



Nephrectomy (removal of the kidney) has been performed 

 many times experimentally on healthy animals, and in human 

 surgery it has taken its place amongst the useful operations. 



