The modern treatment of stone in the bladder by litholapaxy : a description of the operation and instruments with cases illustrative of the difficulties and complications met with . f the blades, the instrument is un-locked, and the screwing is converted into a slidingaction. For the operation of litholapaxy, three varieties ofthis instrument are generally employed:—(1) Alarge fenestrated lithotrite (Fig. 2) for crushing Largeand hard stones. In this the male blade, which isdeeply serrated or toothed, passes through the femaleblade, driving the debris through the opening in thelatter, or tossi
The modern treatment of stone in the bladder by litholapaxy : a description of the operation and instruments with cases illustrative of the difficulties and complications met with . f the blades, the instrument is un-locked, and the screwing is converted into a slidingaction. For the operation of litholapaxy, three varieties ofthis instrument are generally employed:—(1) Alarge fenestrated lithotrite (Fig. 2) for crushing Largeand hard stones. In this the male blade, which isdeeply serrated or toothed, passes through the femaleblade, driving the debris through the opening in thelatter, or tossing it away on either side, so that noblocking of the blades by fragments can occur. (2) xVmedium-sized instrument of the same description asthe last, for dealing withstones of moderate size, orfor use when the urethra isnot sufficiently capacious toadmit the larger lithotrite.(3) A flat-bladed, non-fenes-trated lithotrte (Fig. 3),which is used for reducingfragments into fine powder,after the coarse work of break-ing up the stone has been ef-fected by means of the fenes-trated instruments. This mayalso be used with advantagein crushing very small, andespecially soft, stones. Pig. l, Fio\ 4 illustrates the blades of 12 INSTRUMENTS EMPLOYED IN LITHOLAPAXY. another variety of flat-bladed lithotrite that is some-times employed, in which there is a small opening atthe heel of the female blade. For some time afterI began to practise litholapaxy, I used these flat-bladed instruments a great deal; but I now, as a rule,complete the operation by means of the fenestratedlithotrites alone. When large evacuating catheterscan be passed, as in the great majority of cases, it isunnecessary to reduce the stone to fine sand, as coarsedebris can pass through these tubes into the aspirator,and it is a waste of time to reduce the debris to a finerconsistence than what will pass through the canulsewith facility. Cases will, however, occur in which,from various causes, small canulse only—say, Nos.
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Keywords: ., bookcentury1800, bookdecade188, booksubjecturinarybladdercalculi
