362 
CYSTOTOMY. 
scar being visible six weeks later. There was no sign of stricture. 
(Cadiot and Dollar, “ Clinical Veterinary Medicine and Surgery,” p. 416.) 
Schirrmann removed a large bean-shaped calculus from the urethra 
of a gelding. It lay in the neighbourhood of the scrotum. The opera¬ 
tion necessitated casting. Frohner performed urethrotomy in a gelding 
and removed two calculi as large as a hen’s egg. 
After-treatment is very simple ; the wound is either left completely 
to itself, after being powdered with iodoform, or is cleansed once or twice 
daily. Union occurs more quickly after suturing, but even without it is 
complete in two to three weeks. 
Bad results seldom follow this operation, though healing by first 
intention is very rare. Provided the incision be properly made, infiltra¬ 
tion of urine need not be feared, nor is severe inflammation seen, unless 
the parts were injured before operation. Altogether progress is favour¬ 
able, and if the operation be performed exactly in the middle line there 
is little bleeding. 
In quiet animals cystotomy may also be performed in the standing- 
position, the procedure being as above described. Many persons recom¬ 
mend operating with the animal on its left side, but the general con¬ 
sensus of opinion is in favour of the dorsal position ; chloroform is 
necessary. The urethra is divided over the ischial arch, as in urethro¬ 
tomy, but as the urethra is not easy to find unless filled with fluid, an 
elastic catheter should first be passed into the bladder. After incision the 
catheter is withdrawn, and a grooved director inserted as far as the neck 
of the bladder. The probe must be introduced immediately the catheter 
is withdrawn, as otherwise the urethra will prove difficult to find. 
If only a small calculus or gravel has to be removed, an attempt 
should first be made to pass the forceps into the bladder and reach the 
calculus without a second incision. By gradually opening the forceps, 
whilst still in the neck of the bladder, the latter may without danger be 
so dilated as to allow removal of calculi of considerable size; if not, a 
tenotome or bistoury is passed along the director into the bladder, and 
the constrictor urethrae muscle, just behind the neck of the bladder, 
incised during withdrawal. A special instrument has been made for this 
purpose, but is not absolutely necessary. In France a lithotome, which 
corresponds in construction to the herniotome (fig. 129), is employed. 
To prevent injury, the rectum is emptied before operation, and the 
incision made, not exactly in the middle line, but a little to the left or 
right. In dealing with large calculi, the constrictor urethras may be 
incised in two directions. 
The forceps (fig. 163) are now passed, and attempts made to grasp the 
stone; the operation wound being meanwhile closed to prevent the 
bladder entirely emptying; otherwise the wall of the bladder is apt to 
