884 
PROLAPSE AND INVERSION OF THE URTNARY BLADDER, 
swelling, either in the vagina or protruding beyond the vulva (Fig. 171). 
The swelling appears elastic, owing to the inverted organ containing 
peritoneal fluid, is covered by the mucous membrane of the bladder, and 
two folds appear in it, the orifices of the ureters. By lifting up the 
swelling, or pressing on it, or by movement on the part of the animal, 
urine (from the distended ureters) is discharged in two streams (fig. 171). 
The mucous membrane gradually dries by continuous exposure to the 
air, is soiled by dirt and dust, and may finally become necrotic. When 
the condition has existed for a long time stenosis of the urethra may 
lead to strangulation of the bladder, which is shown by severe congestion, 
and sometimes ends in rupture. Injury to its walls causes the swelling 
to subside. 
Prognosis. Prolapsus vesicae is evidently graver than inversion, as 
the peritoneal cavity is opened and peritonitis is liable to occur, a danger 
which is absent in inversion. Beposition is only possible in recent 
prolapse, where the serosa of the bladder has undergone no considerable 
change. Otherwise septic peritonitis occurs, and invariably proves fatal. 
The prognosis is more favourable in inversio vesicse; the mucous mem¬ 
brane of the bladder possesses greater resistance, and even when, after 
successful reposition, irritation is marked, cure is not impossible. The 
animal’s progress depends principally on the condition of the mucous 
membrane and on the calibre of the urethra. As long as these allow of 
reposition, the operation must be attempted, as, in the event of its failing, 
nothing remains but amputation of the bladder. In distinguishing the 
inverted bladder from foetal membranes, the directions given under 
“ Prolapse of the Bladder” must be borne in mind. Failure to distin¬ 
guish inversion of the bladder from foetal membranes has sometimes led 
to awkward consequences both for patient and operator. 
Treatment. Provided the serous coat of the prolapsed bladder is 
little changed, it should be carefully cleansed with disinfectants and 
attempts made to replace the viscus. At the same time the wound in 
the vagina must receive attention. Unless the animal strain much, a 
repetition of the prolapse need scarcely be feared, and can be provided 
against by injecting lukewarm fluid into the replaced bladder. Riviere 
diagnosed prolapse of the bladder in a cow soon after birth. The 
rupture in the vagina was 3-J inches in length. After discharge of the 
contents, the bladder was replaced by using a piece of hollow elder stick, 
and though severe straining ensued, the condition did not recur. 
Recovery was complete. When the rupture in the lower wall of the 
vagina lies not far from the vulva an attempt might be made to suture 
it, to prevent recurrence and to guard against the passage of urine into 
the abdominal cavity. 
When the bladder becomes inverted, the first point is to effect reposition 
