. Surgery, its principles and practice . theters lying well within their channel or channels,according to the particular instrument in use, search is made for one of theureteral openings. They are to be found at the upper angles of the trigone,about three-quarters of an inch from the median line, and al)out an inchfrom the inner extremity of the urethra. They are to be recognized assmall slits or dimples in the memljrane, possibly on the apex of a littlepapilla; and their recognition is confirmed by observing the issuance fromthem, at short intervals, of jets of urine that swirl in the surroun
. Surgery, its principles and practice . theters lying well within their channel or channels,according to the particular instrument in use, search is made for one of theureteral openings. They are to be found at the upper angles of the trigone,about three-quarters of an inch from the median line, and al)out an inchfrom the inner extremity of the urethra. They are to be recognized assmall slits or dimples in the memljrane, possibly on the apex of a littlepapilla; and their recognition is confirmed by observing the issuance fromthem, at short intervals, of jets of urine that swirl in the surrounding fluidin a characteristic manner. If this urine is tinged with blood or pus, orartificially, by previous hypodermic injection of indigo-carmin solution,it is even more readily recognized. The openings of the ureters are notalways placed at the same location, nor are they always symmetricallylocated; one may be quite near the median line, the other at a consider-ably greater distance from it. Peristaltic movements either of the blad-. FiG. 164.—Showing the Short Distance Bridgew by theCatheter in the Direct Method, Universal Cystoscope. DIAGNOSIS OF VESICAL AFFECTIONS. 289 der or of the intestines behind it produce changes in their location andrelationship, even in the same individual. Inflammatory conditions of the bladder-membrane often increase thedifficulty of detecting the ureteral openings, by adding to the number ofdimples and depressions that resemble the openings, or by sinking thereal opening into the edematous membrane in such a way that it is noteasily recognized. But experience and practice will remove much ofthis difficulty. A ureteral opening having been detected, the cystoscope is brought asnear as may be to it, the catheter is aimed at and pushed into it, thengradually threaded up the ureter as far as appears desirable. If it is de-sired only to draw urine from that kidney, the insertion of the catheterfour or five inches will be sufficient; but if it is d
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