A case of suprapubic cystotomy in which the bladder was distended with air instead of water, and four hundred and ninety-five calculi removed / by W.W. Keen.

  • Keen, William W. (William Williams), 1837-1932.
Date:
[1893?]
Catalogue details

Licence: Public Domain Mark

Credit: A case of suprapubic cystotomy in which the bladder was distended with air instead of water, and four hundred and ninety-five calculi removed / by W.W. Keen. 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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    sible with the Nelaton catheter, that wlien tolerance to its passage is established the patient shall be taught how to use it, and that he shall then be sounded for stone and operated on. If the bladder and urethra still remain intolerant after a time, a .<u])rapubic cystotomy should be done. A full dose of morphia was given to quiet him. June 19, ]80o.—He has passed a very much more comfortable forty-eight hours, and the urine is now but little discolored with blood. He is still passing small fragments of calculi, and his gen- eral condition, although improving, is far from satisfactory. Operation, July 8, 189S.—The caliber of the urethra was only 19 (Fr.), and the urethra was still so irritable and sensitive that I did not feel justified in attempting to dilate it sufficiently for litholapaxy, especially as he was sutfering so much that immediate relief was demanded. Moreover, as the prostate gland might need to be excised, T determined upon suprapubic cystotomy. I adopted the suggestion of Dr. A. T. Bristow {Annals of Sur- gery, June, 1893), and injected nine ounces of air into the bladder* This distended the bladder satisfactorily, forming a distinct elastic tumor to the touch in the middle line. At its upper part was a rounded tumor an inch and a half in diameter, which I had not seen, but was explained later as a distended pouch of the bladder. An incision in the middle line discovered the bladder very w^ell. The peritoneum was not seen. As soon as the bladder was incised the air immediately escaped, the edges of the bladder -wall were seized by hemostatic forceps, and the finger thrust into the bladder. In a moment I discovered a large number of small stones lying in the pouch behind the prostate. These were removed chietly by a scoop, and when counted after operation were found to be four hundred and ninety-five in number, the majority of them very small. The weight of the whole number was three hundred and eighty-six grains. About fifty or more w^ould range from a diam- eter of twenty-six to thirty-two of the French catheter scale. The mucous membrane of the bladder was then examined by an electric light. It was markedly red and velvety. This explained the hemorrhage. At the upper part of the bladder a pouch was found with several stones lying in it. Its mouth was easily seen by the electric light. This pouch was undoubtedly the small tumor above referred to,