URINE. 



taken, however, to keep the ftilet drawn back fome diftance 

 from the extremity of the inftrument. By thefe precau- 

 tions, fays Default, the catheter may always be got into the 

 bladder. Should the introduAion prove neither painful nor 

 difficult. Default thought it would be better not to annoy 

 the patient by making him continually wear the inftrument, 

 unlefs its prefence in the urethra were eftentially neceffary to 

 deftroy the caufe of the retention of urine, as it would be 

 in the inftance of urinary fwellings. 



1 6. Ri-tent'wn of Urine from D'lfeafe of the ProflaU 



Gland. As Default remarks, it would be fuperfluous to 



endeavour to prove by examples the reahty of this fpecies of 

 retention of urine. If the faft were not eftablifhed by a 

 multitude of obfervations, we (hould be convinced, by advert- 

 ing to the relation of the proftate gland with the commence- 

 ment of the urethra, and underftanding how this canal is 

 only compofed of a dehcate membrane, that the gland coidd 

 not be affefted with fwelling, without leffening in fome de- 

 gree the tube which it embraces. 



An enlargement of the proftate gland may depend on in- 

 flammation, abfcefles, calculi formed within its fubftance, 

 a varicofe fwelling of the veffels which furround it, or on a 

 fcirrlious tumour and induration of it. 



When a retention of urine arifes from inflammation of the 

 proftate, it makes its attack very fuddenly, and rapidly 

 increafes. The patient at firft complains of a fenfe of heat 

 and weight about the perineum, and very foon afterwards 

 of a continual throbbing pain about the neck of the bladder. 

 This pain is feverely increafed, when the patient goes to 

 ftool ; and he is afflifted with tenefmus, and frequent in- 

 clination to make water. He feels alfo as if a large mafs 

 of excrement filled the extremity of the reftum, and were 

 ready to come out. When the finger is introduced into 

 the bowel, the projeftion of the proftate can be felt at 

 its anterior part. J. L. Petit adds another fign of a fwell- 

 ino- of this gland : " Si I'on eft curieux de voir les nialades 

 alter a la felle, lorfqu'ils rendent des excremens durs, on 

 trouvera que la partie interieure du boudin forme par les 

 matieres fecales, fera creufee, comme ayant pafle fur !a 

 faillie, que forme la proftate dans la partie antcrieure du 

 reftum." Bichat conceives, however, that fuch an appear- 

 ance may be obliterated in the paftage of the excrement 

 through the fphinfter ani. When the patient attempts to 

 make water, it is a long while before the firft drops come 

 out ; and if he fhould now increafe the efforts, he makes an 

 additional impediment, by puftiing the fvvoUen proftate more 

 and more againft the neck of the bladder, the aperture of 

 which becomes ftopped up, and no water can be voided, 

 until the efforts are leffened. The ftream of urine is fmaller, 

 and the pain arifing from its expulfion more acute, in pro- 

 portion as the inflammation of the proftate is more confider- 

 able. We may alfo add, as a particular fymptom of this 

 fort of retention of urine, that if an attempt be made to in- 

 troduce a catheter, it paffes without the leaft refiftance as 

 far as the proftate, where it ftops, and caufes great pain. 

 The pulfe is hard and frequent ; there is much thirft ; and 

 all the ufual fymptoms of fever prevail. 



This kind of retention of urine, as well as all thofe which 

 originate from an enlargement of the proftate gland, or 

 other obftruftions in the canal, are, according to Default, 

 generally more dangerous than other cafes, which merely 

 depend upon the weaknefs of the bladder, and in which 

 there is very little riflt of this vifcus giving way. 



When the ui-ethra is free from obftruftion, the urine, 

 after diftending the bladder to a certain degree, generally 

 oozes through that canal ; and the patient may live in this 

 condition for years, without any alarming confequences. 



But the cafe is different, when the retention of urine de- 

 pends upon any ftoppage or ilrifture in the urethra. The 

 urine does not then partially efcape ; this fluid ftagnates in 

 the bladder ; the diftention increafes ; and if fpeedy relief 

 be not afforded, that vifcus inflames and floughs, and a 

 perilous effufion of its contents enfues. 



In the retention arifing from inflammation of the proftate, 

 the indication is obvious : it is to ufe every poflible means 

 of refolving the inflammation. Venefedlion, leeches to the 

 vicinity of the anus, the warm bath, emollient clyfters, and 

 poultices, are the remedies which ieem moft eligible. Thefe 

 muft be affifted with a regimen ftriftly antiphlogiftic. 



It muft be confeffed, however, that the efficacy of thefe 

 means is often too flow, and the fymptoms too urgent, to 

 allow us to wait for the urine to flow of itfelf. Frequently, 

 alfo, the tone of the bladder is fo much weakened by the 

 diitention, that this organ cannot expel its contents. The 

 catheter muft then be employed ; but the conlraftion of 

 that part of the urethra which runs through the proftate, 

 fometimes renders the introduction of this inftrument diffi- 

 cult, and always very painful. 



According to Default, a large catheter generally anfwers 

 better than a fmall one, and it may either be of filver or 

 elaftic gum. The latter, though the beft for the purpofe 

 of being kept in the paffage, has not always fufficient firm- 

 nefs to get through the obftruftion in the canal, not even 

 with the aid of the ftilet. In this refpeft, a filver catheter is 

 fometimes preferable. But whatever may be the kind of 

 catheter employed, it generally paffes as far as the proftate 

 with perfe£l facility, where it is ftopped, not only by the 

 narrownefs, but alfo by the new curvature, of the paffage : 

 for the proftate cannot be enlarged, without puftiing for- 

 wards and upwards, or to one fide, that portion of the 

 urethra behind which it is fituated. This circumftance 

 ought never to be forgotten, in regulating the length and 

 dirtftion of the beak of the catheter, which Ihould alfo be 

 longer, have a more confidcrable curvature, and be more 

 elevated, at the time of its introduftion, than in other cafes 

 of obftruftion in the urethra. 



In fwellings of the proftate gland, Mr. Hey has parti- 

 cularly pointed out one advantage which belongs to elaftic 

 catheters, viz.. that their curvature may be increafed while 

 they are in the urethra. This gentleman was introducing 

 an elaftic gum catheter in a patient, whofe proftate gland was 

 much enlarged, and finding fome obllruttion near the neck 

 of the bladder, he withdrew the ftilet ; in doing which, he 

 accidentally repreffed the tube, which then went into the 

 bladder. In faft, he found that the adl of withdrawing the 

 ftilet increafes the curvature, and hfts up the point of the 

 catheter. Praft. Obf. in Surgery, p. 399. edit. 2. 



After being tolerably certain, fays Delault, that the end 

 of the catheter correfponds exactly to the direction of the 

 urethra, and that the obftacle to its entrance into the bladder 

 only depends upon the narrownefs of the paffage, we may, 

 without being too fearful of making a falfe paffage, forcibly 

 pufh forward the catheter. This inftrument will certainly 

 rather dilate a canal, that already exifts, than form a new 

 paffage for itfelf. Default confcffes, however, that this 

 plan would be attended with great danger in the hands of 

 young inexperienced furgeons ; and he adds, that it is only 

 fit to be praftifed by thofe, who, combining great ex- 

 perience in the ufe of the catheter with an accurate know- 

 ledge of the different curvatures of the urethra, have at 

 length attained that degree of ftill, winch never lets them 

 lofe fight of the fituation and direction of the beak of the 

 catheter. For, fays he, if, wiiile tiie inftrument is forced 

 forward, the beak fhould be inclined too low, or to one 



fide. 



