OPERATIONS ON THE BLADDER. 121 



of these cases, or even to fix the patient firmly, as if the bladder 

 is much distended rupture or sudden collapse is apt to occur ; 

 two such cases have occurred in the College Out-patients' 

 Clinique during the past two years. As regards sequelae, in 

 so far as the operation itself is concerned, if antiseptic pre- 

 cautions are observed no evil results need be feared ; it can 

 be depended upon to give great relief, and, if the patient is 

 not too much exhausted, or the cause of the distension is not 

 some permanent obstruction in the urethra or neck of the 

 bladder, the benefit is usually immediate and permanent. 



Lithotomy and Lithotrity.— Both these terms are applied to 

 the operation whereby calculi are removed from the bladder, 

 the first term being used when the bladder is incised and the 

 stone or stones extracted, and the latter when the calculi are 

 first crushed or broken up into fragments sufficiently small to 

 be removed through the urethra. 



Lithotomy is performed as follows. After the bladder has 

 been emptied with a catheter, and carefully washed out with 

 solution of chinosol, boric acid, or some other antiseptic, the 

 patient is anaesthetised and placed in the dorsal position, 

 laparotomy being performed as already described. The site 

 of operation in the male is either on the median line imme- 

 diately in front of the penis, or else in the flank a little to 

 the right or left of that organ, and in the female on the 

 median line immediately in front of the edge of the pelvis. 



The bladder is carefully raised and drawn into the wound 

 where it is packed round with antiseptic lint ; a longitudinal 

 incision is made down its centre in the least vascular portion, 

 as near as possible directly over the stone. This is carefully 

 removed with forceps, after having been first broken up with 

 a lithotrite, if at all a large one. If, as is not uncommon, it 

 is adherent to the interior, care must be taken to loosen it 

 very gently from its attachments. If a number of small stones 

 are present they must be removed with a blunt scoop or forceps. 

 The interior is then carefully washed with some trustworthy 

 non-irritant antiseptic, and the edges drawn together with 



