URINAEY LITHIASIS. 517 



Death is the inevitable sequel after a longer or shorter time. When 

 large calculi have been arrested, or rather developed, in the bladder 

 the same symptoms occur should the calculus be thrust towards the 

 neck of the bladder so as completely to obliterate the passage. This, 

 however, is a very rare accident. As a rule the obstruction is merely 

 temporary, and the resulting vesical colic and retention last but a 

 short time. The displaced calculus falls back again into the lower 

 part of the bladder, where it is retained, and the urinary passages 

 again become free. 



Diagnosis. The diagnosis is sometimes extremely easy, but it may 

 present serious difficulty. 



"When the urethra is obstructed, the symptoms are so striking that 

 there can scarcely be any doubt; but the diagnosis of renal calculus, 

 nephritic colic, calculus in the bladder, and rupture of the bladder 

 demands more attention. Examination of the urinary organs through 

 the rectum then proves of great service. 



Prognosis. The prognosis is grave in all cases, because of the pos- 

 sibility of the urinary passages being obstructed, so that surgical inter- 

 ference is necessary. 



Lesions. The lesions caused by urinary calculi may vary greatly. 

 Though insignificant and scarcely apparent in certain cases, they are 

 often very marked, and comprise simple or suppurative i^yelitis, in- 

 flammation of the ureters, hydro-nephrosis, cystitis of varying intensity, 

 urethritis, and inflammation of the sheath. 



Treatment. All farmers who fatten their animals know that the 

 use of alkaline drugs, such as bicarbonate of soda, together with 

 diuretics, linseed, barley and pellitory diminish the danger of urinary 

 calculus formation. Bicarbonate of soda is often given with this object, 

 and is excellent in cases where lithiasis does not extend beyond the 

 production of sandy or muddy deposits. By rendering the urine more 

 alkaline it prevents the growth of sal)ulous deposits, and may even 

 cause slow but jjrogressive solution of concretions already formed. 

 When, on the other hand, the urethra is obstructed, and urine is 

 retained, early surgical treatment (urethrotomy) alone offers any chance 

 of preventing rupture of the bladder. 



Certainly it is possible, as recommended by the older practitioners, 

 to try massage of the glans penis and urethra opposite the obstruction, 

 and, after withdrawing the penis, to attempt to loosen and eject the 

 obstructing matter. But such attempts very frequently fail, because 

 the material is too firmly fixed, and no time must be lost. 



Urethrotomy is usually practised at one of two points, according to 

 circumstances — firstly, opposite the ischial arch; and, secondly, opposite 

 the S-shaped curve. 



