A case of encysted vesical calculus of unusually large size removed by supra-pubic cystotomy / by Walter Rivington.

  • Rivington, Walter, 1835-1897.
Date:
1886
Catalogue details

Licence: Public Domain Mark

Credit: A case of encysted vesical calculus of unusually large size removed by supra-pubic cystotomy / by Walter Rivington. 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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    his water properly. The bladder was very irritable. Signs of cystitis were present, the urine being amtnoniacal and containing pus. There was not more albumen than the pus would account for. The bladder was washed out, at first with a weak solu- tion of carbolic acid (1 in 400), and afterwards with iodo- form in mucilage, and he was ordered some infusion of buchu and tincture of hyoscyamus three times a day, as well as two drachms of confection of senna to be taken every morning. Under this treatment, combined with rest, he improved. The pain diminished in severity, the bowels acted better, and he was able at times to pass his urine more naturally. On examination per rectum a large round smooth swelling, very firm and hard, was felt anteriorly in the situation of the prostate gland, and suggested either an unusually enlarged prostate or the presence of a prostatic calculus. Nothing could be detected, either in the pros- tatic urethra or in the bladder, by means of the sound. The patient was asked to make water into a porringer-, and the stream was found to drop from the end of the penis, as it does in cases of enlarged prostate. It was decided to advise an examination under an anaesthetic, and a median urethrotomy for the purpose of exploration and subsequent drainage of the bladder, any further pro- cedure being dependent on the result of the examination. The patient gave his consent to any pi'ocedure that might be considered desirable. On the 24th of February he was taken to the operating theatre and anassthetised. Nothing could be detected with the sound. A grooved staff was then passed into the bladder, and, the patient having been placed in the ordinary lithotomy position, an incision about an inch long was made in the middle of the perineum, and the membranous urethra was opened in front of the pros- tate. Exploration with the finger failed to detect any- thing abnormal in the prostate, but it was ascertained that the hard, rounded mass was not connected with the