LITHOTOMY 379 



rough it may require considerable time and much patience, 

 but if smooth the work is a matter of but a few moments. 

 During the execution of these manipulations it is important 

 that the anaesthesia be so profound as to eliminate all reflexes 

 that would tend to provoke contractions of the urethral 

 muscles. 



The feat is not a difficult one when the incision has been 

 made as described in Step I, but if made at a lower level the 

 extraction of large stones without previously crushing them 

 is either impossible or else inflicts irreparable injury. 



Modifications of this technique may be found necessary, 

 where the stone is large and the animal small. In this event 

 pulverization and evacuation by irrigation or suction (lith- 

 olapaxy) may be necessary. This is done by introducing 

 the lithotrite into the bladder and then patiently pulverizing 

 the stone piece by piece until it has been reduced to small 

 fragments, which are then washed out by forcible irrigation, 



Fig. 192 — Ultzmann's Evacuator for Litholapaxy. 



or else by use of the evacuator, — a special instrument which 

 abstracts the detritus by suction. (Fig. 192.) The frag- 

 ments may also be removed one after the other with the 

 forceps. 



The crushing of stones in the bladder is, however, often 

 impossible on account of their flint-like hardness which re- 

 sists any instrument small enough to be introduced into the 

 bladder of a horse through an urethral incision. 



Third Step. — Suturing the Wound. — Although it has been 

 the custom to leave the incision to slowly heal without clos- 

 ure, more recently it has been demonstrated that suturing 

 shortens the period of convalescence, and forestalls compli- 

 cations. Between the two methods of suturing the wound 

 and of treating it as an open one through which the urine is 

 voided until spontaneous closure occurs some weeks or even 

 months later, the author recommends the former, which co- 

 incides with the conclusions of White, who has performed 

 many such operations upon dogs. 



