Litholapaxy or rapid lithotrity with evacuation / by Henry J. Bigelow.

  • Bigelow, Henry Jacob, 1818-1890.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Litholapaxy or rapid lithotrity with evacuation / by Henry J. Bigelow. 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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    fairly within ; and I have known its further entrance, after slid- ing over this obstacle, to be erroneously explained by assuming the existence of a second or hourglass cavity in the bladder itself. To obviate this diflficult}^ and so soon as the triangular ligament is passed, a catheter, if curved, should be pressed through the indurated neck or prostate in the direction of the axis of the body, by the hand on the perimeum, — a most effi- cient manoeuvre, when the prostate is large. If there be further difficulty, the tip should of course be sought and guided in the rectum. After introduction, a straight tube or the shaft of a curved one often returns to an angle of about 45° with the recumbent bod}^ and, if the patient is not etherized, a feeling of tension may then be relieved by depressing, with the hand upon the pubes, the suspensory ligament of the penis, — an expedient also useful during the passage of the instrument. ]\Iy own practice has always been to etherize for lithotrity. Each operator prefers the position to which he is accustomed ; and when the urethra is healthy, this is of very little import- ance. But if there be obstruction, a position at the patient’s left side enables the operator to introduce a catheter or litho- trite to advantage with the right hand, leaving the left hand free to act in the perineeum. After the instrument is intro- duced, and both hands are required above the pubes, they are most available, if the surgeon changes his position and stands upon the patient’s right. I also introduce the straight tube on the right side. It is important by a preliminary injection to ascertain care- fully the capacity of the bladder by emptying it and then re- filling it slowly with warm water previously measured, until the water is expelled through the loosely held urethra by the side of the tube. In this way we prevent its over-distention. In the etherized subject a short pipe or nozzle suffices for this purpose. I have for many years employed a common David- son’s syringe. An unetherized patient may for a moment resist this injection through a short tube by contracting the sphincter of the bladder ; but this readily yields. Except in a large blad- der, a distention l)y eight or ten ounces suffices for breaking the stone. The smaller the injection of water, the more readily, indeed, do fragments fall into the blades of the instrument. But, unfortunately, so also does the mucous membrane. In