The Brooklyn Medical Journal. Vol. II. No. 2. Aug., 1888Various
Science
The Brooklyn Medical Journal. Vol. II. No. 2. Aug., 1888
Various
Medicine -- Periodicals
A. F. McGill, F.R.C.S. (_The Lancet_, February 4, 1888). The operation
consists of two parts: (1) The opening and drainage of the bladder; and
(2) The removal of the prostatic valve which prevents the egress of the
urine. A full sized silver catheter, curved according to the nature of
the case, is passed into the bladder, its contained urine withdrawn and
its cavity washed out with a warm saturated solution of boracic acid
till this is returned clean and unchanged. The usual rubber rectal bag
is now introduced and filled with fourteen ounces of water. The bladder
is now rendered prominent by injecting it with a sufficient amount of
warm boracic acid solution. The catheter is retained in the bladder, and
the fluid with which the latter has been distended, prevented from
escaping. The usual median supra-pubic incision is now made, the bladder
exposed and made to project into the abdominal wound by depressing the
catheter. A large curved tenaculum is now passed transversely into the
bladder, touching as it goes the point of the catheter. An incision is
now made longitudinally through the bladder wall, the fluid being
prevented from escaping by plugging the opening with the finger. The
bladder is now seized with nibbed forceps, and applied on each side of
the incision, the catheter is withdrawn from the urethra and the bag
from the rectum, and the first part of the operation is complete. The
interior of the bladder and its neck is now examined, in order to
ascertain the exact nature of the prostate enlargement. A pedunculated
middle lobe can be removed with the curved scissors, but in the case of
a sessile middle lobe, this must be assisted with the finger and
forceps. The “collar” enlargement is removed with greater difficulty. In
order to insure the patency of the urethra, it is advised to pass the
forefinger into the canal as far as the first joint. It is claimed that
the hæmorrhage is not excessive. The operation completed, drainage is
effected by passing a rubber tube out of the abdominal wound, the latter
being partially closed by a point or two of suture. The tube is removed
after forty-eight hours.
The author’s experience is limited to five cases, four of which have
proved successful, while the fifth case is still under treatment. He
claims that, in cases operated upon early, before diseased bladder or
surgical kidney have developed, a radical cure may confidently be
expected.
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