The Abdomen 235 



The term lithotrity is used to designate the operation of crush- 

 ing the stone by means of a lithotrite, wielded through an opening 

 made in the urethra, and leaving the fragments to be washed out 

 by the subsequent flow of the urine, and the term litholapaxy the 

 crushing and removal of the fragments at one and the same opera- 

 tion. When the urethral method of removal is followed, litholapaxy 

 should be practiced, as good surgery aims to make certain the re- 

 moval of every vestige of concretion within the organ, so that 

 none may remain to form a nidus for further accretion or to become 

 an obstruction in its passage through the urethral canal. In fact, 

 it goes without saying, that lithotrity should never be practiced. 

 When the stone is lodged at or near the neck of the bladder in the 

 male the preferable way to effect its delivery is to force it back 

 within the bladder by means of the flexible metal sound or a bougie 

 and then remove it by prepubic lithotomy. 



Whenever calculi are extracted from the bladder by direct oper- 

 ation, the ureters should also be explored to make certain that they 

 do not also contain such bodies. Sutton describes an instance where 

 he observed calculi lodged in both the bladder and ureter at the 

 same time. 



The medicinal remedies employed in alkaline or catarrhal li- 

 thiasis are benzoic preparations and salol, together with the milk 

 diet. 



Irrigation of the bladder with antiseptic solutions by means of 

 the catheter should also be resorted to, the object being to allay any 

 tendency to cystitis or to alleviate it if it has developed. 



TORSION. RETROFLEXION. 



Torsion of the bladder was witnessed twice by Siedamgrotzky. 

 In one instance it was caused by the presence of a subserous hema- 

 toma near the neck of the organ, in the other through an omental 

 sarcoma becoming adherent to the neck. 



Retroflexion is a condition in which the viscus is bent abruptly 

 back into the cul-de-sac of Douglas under extreme expulsive efforts 

 in subjects suffering from prostatic enlargements of other form of 

 obstruction, and forms a subcutaneous swelling in the peri-anal 

 region (see Perineal Hernia). 



Symptoms and Diagnosis. In torsion and in some cases of 

 retroflexion suppression of micturition takes place as a result of 



