234 Surgical Diseases and Surgery of the Dog 



the mucosa. Sometimes they occur as calculi of smaller or larger 

 dimensions. The bladder may be completely filled by them so that 

 the urine must percolate through drop by drop (Kitt). At other 

 times, large single calculi are found, oval in form and closely con- 

 forming to the shape of the bladder. Johne saw one which meas- 

 ured 1 1 cm. in length, 7.5 cm. in width, and 6 cm. in thickness, and 

 which weighed 490 grams. 



Symptoms and Diagnosis. Acid calculi in the bladder affect 

 the organ in no greater degree than they do the kidney. It is the 

 larger alkaline concretions with which we have principally to do fh 

 this organ. As already stated, they usually occur concurrently 

 with, and probably as a result of, catarrhal cystitis. Hence pus is 

 generally present which, makes the urine very turbid. The wall of 

 the bladder is greatly h3fpertrophied, and ulceration of the mucosa 

 with hemorrhage is common. Johne observed small polypoid 

 growths and it is not uncommon to find the smaller calculi em- 

 bedded in the mucosa. 



The presence of the large cystic calculi can in most cases be 

 detected by abdominal palpation. They are felt on the floor of the 

 bladder. When calculi lodge in the neck of the bladder they induce 

 symptoms similar to those which are seen when the urethra is 

 obstructed. 



Treatment. This can only be by operative interference. The 

 removal may be effected by either of three operations, viz., prepubic 

 lithotomy, lithotrity, or litholapaxy. 



The preferable operation in all vesical cases, excepting in the 

 female, is prepubic lithotomy or removal by celib-cystotomy, for 

 the reason that the prostatic portion of the urethra is often not 

 penetrable by instruments owing to enlarged prostate, and the ure- 

 thral method is not suitable for multiple or very hard calculi or for 

 encysted stones. The prepubic method affords better access to the 

 interior of the viscus and involves no more risk than does perineal 

 section, provided careful technic be observed. Moreover, it obviates 

 the necessity of the practitioner providing himself with a cumber- 

 some array of several sizes of lithotrites and an evacuating bulb. 

 In twelve cases of prepubic extraction reported by Malzew there 

 were only two fatal results. 



In the female, the dilatability of the urethra more readily per- 

 mits of litholapaxy. 



