On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other : being the dissertation for which the Jacksonian Prize for 1838 was awarded / to Edwin Lee.

  • Lee, Edwin, -1870.
Date:
[1842]
Catalogue details

Licence: Public Domain Mark

Credit: On the comparative advantages of lithotomy and lithotrity : and on the circumstances under which one method should be preferred to the other : being the dissertation for which the Jacksonian Prize for 1838 was awarded / to Edwin Lee. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    bilitv. These accidents arc not necessarily in proportion to the severity and difficulties of the operation ; but they may also occur when the sitting has been attended with but little pain, and when the stone has been easily broken, especially if, from the compara- tive freedom from pain,'the surgeon has been induced to prolong the sitting by attempting to do too much at once. Other acci- dents to which lithotrity may give rise, are bleeding from the urethra or bladder, (though seldom to an extent productive of much inconvenience ;) pain at the neck of the bladder with irritabi- lity of the organ ; inflammation of the prostate and abscess, which may cause retention of urine. These are sometimes attributable to the strain on the parts inconsequence of the urethra being for- cibly straightened by the introduction of and manoeuvres with a straight indexible instrument, and hence arc more liable to happen when the curve of the urethra is naturally greater than usual, or when it has become so from enlargement of the middle lobe of the prostate. Another serious accident peculiar to lithotrity, and of more fre- quent occurrence, is the arrest of fragments in some part of the urethra. The portion of this canal enclosed by ihe-y/aws penin being generally narrower than other parts, fragments which have been expelled as far as the fossa 7iavicularis, arc frequently ar- rested at this point, whence they may generally be removed by a blunt hook passed behind them, or by crushing them with a forceps constnictcd for the purpose. When, however, this cannot be effect- ed, the incision of the orifice of the urethra with the urctotome will be necessary ; indeed, as I have before stated, this incision is sometimes required previous to the operation, in order to admit the litholrite. Other parts of the urethra at which portions of calculi are most likely to be arrested, are the point opposite the bulb, and the membranous part where the canal is narrowed by the suspensory ligament. liy introducing a straight full-sized bou- gie or sound as far as the obstacle, the fragment will in many cases be expelled on the patient’s endeavouring to make water as soon as the instrument is withdrawn. Should this not succeed, the fragment may generally be pushed back into the bladder, to be broken at a subsequent sitting. Of the instruments invented for breaking calculi or fragments in the urethra, when they can neither be expelled nor pushed back into the bladder, the ingenious one lately constructed by Mr Weiss a]ipcars well calculated for the purpose. It consists of two elastic blades enclosed within a canu- la. When the canula is drawn back the blades open by their own elasticity, and separate the parictes of the urethra, ena- bling the operator the more readily to pass them on cither side of the fragment which is thus fixed between them by advancing the canula, and is broken down by rotating a central rod with a head