. A manual of operative surgery . all ; electric head-lamp. The Operation.—The pelvisbeing raised, the bladder isgently distended with sterilisedwater introduced through arubber catheter. Through amedian incision made imme-diately above the pubes thebladder wall is exposed and in-cised with the aid of the sharp hook. The incision should be small,and the index finger should at once be introduced to examinethe growth, to ascertain its exact point of attachment, its degreeof firmness, and the width of its base. In three out of fourcases both of innocent and malignant tumours the attachmentwill be
. A manual of operative surgery . all ; electric head-lamp. The Operation.—The pelvisbeing raised, the bladder isgently distended with sterilisedwater introduced through arubber catheter. Through amedian incision made imme-diately above the pubes thebladder wall is exposed and in-cised with the aid of the sharp hook. The incision should be small,and the index finger should at once be introduced to examinethe growth, to ascertain its exact point of attachment, its degreeof firmness, and the width of its base. In three out of fourcases both of innocent and malignant tumours the attachmentwill be found in the region of the trigone, on the posterior is now necessary to introduce a speculum through the bladderwound, which may be enlarged with a bistoury for this edges of the vesical wound are secured with two long silksutures, which serve as retractors, or with a blunt hook. Avaginal speculum, or a metal caisson, is then introduced and allfluid mopped up with sponges, and the tumour inspected by means. FIG. 147.—VILLOUS PAPILLOMA OF POS-TERIOR WALL OF BLADDER WITHMUSCULAR HYPERTROPHY. 590 ABDOMINAL OPERATIONS [part ii of a head-lamp. In many cases the tumour can be dealt withthrough the speculum, which has the advantage of preventingaccess of urine during the manipulation. If, however, the baseof the tumour is too broad for this, it is unsuitable for this formof operation, and can only be removed by some method whichaims at excising the whole thickness of the wall of the bladder. The growth, when exposed through the caisson and carefullyexamined by inspection, may be found to have a narrow pedicle,a broad pedicle, or be sessile. The last two conditions are evidenceof malignancy, and unless the surgeon is prepared to excisepart or whole of the bladder wall, nothing more can be donethan removal of the projecting mass as a palliative the case of a villous tumour with a narrow stalk, not onlymust the stalk be removed, but also a considerabl
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