PUNCTURE OF THE BLADDER. 
373 
III.—PUNCTURE OF THE BLADDER (PUNCTIO 
VESICAS). 
When the discharge of urine by the natural passage is hindered, 
the urinary bladder becomes enormously distended, and puncture by 
trochar is resorted to to prevent rupture. The operation was first 
practised in man, and is still employed in dysuria, parti¬ 
cularly when following enlargement of the prostate. The 
trochar used for the horse is an enlarged copy of that 
constructed for the above purpose by Flourant (fig. 169). 
Pilger described the operation more exactly, and later it 
was frequently employed in oxen which suffer from 
urethral calculi. Before attempting it, the diagnosis of 
over-distended bladder must be verified by rectal exami¬ 
nation. In the horse the distended bladder extends 
downwards and forwards, that is, towards the abdo¬ 
minal cavity. In oxen and bulls the extension takes 
place more towards the sides. Even in the horse, how¬ 
ever, the bladder does not reach the lower wall of the 
abdomen; this condition is only seen in swine and 
carnivora, in which the bladder, when filled, lies to a 
great extent in the abdominal cavity. It need scarcely 
be said that, before making the attempt, all simpler 
means, as, for instance, the use of the catheter, should 
have been tried. 
The bladder may be reached from different points if 
Flourant’s form of trochar, which is moderately bent 
(fig. 169), be employed. These different methods of 
puncture are distinguished. 
(1) The punctio vesicse suprapubica, which is now 
most generally used in man, is impracticable in herbi- 
vora, because in them the lower part of the bladder is 
not attached to the wall of the abdomen, and in the 
horse and ox the bladder would be only reached 
through the peritoneal cavity. In swine and dogs it 
can, however, be approached from the lower abdominal wall, and this 
path is to be preferred because the more convenient method of operation 
through the rectum employed in larger animals is here attended with 
difficulty. Hering, who recommends this operation for dogs, places the 
animal on its side, and, after making an incision through the skin, passes 
a thin trochar into “ the tensest portion of the swelling in the lower region 
of the flank.” In man the operation is done in the dorsal position and 
close to the linea alba, and the same procedure has been recommended 
Fig. 169 .— 
Flourant’s trochar. 
