Operative surgery . catheterism of the ureter thorough asepsis shouldbe ])racticed in all respects to prevent infection of the kidney. The urethrashould be stretched carefully, so as not to cause needless dilatation and lossof power. The speculum should be introduced with relation to the curveof the arch of the i)ubis to avoid injury of the urethra. Careful introduc-tion of instruments into the ureter and kidney is urged to prevent perfora-tion of the former, and puncture of the latter, structure. The Remarks.—If fluid obscures the ureteral orifice, withdraw it bymeans of the evacuator (Fig. 1
Operative surgery . catheterism of the ureter thorough asepsis shouldbe ])racticed in all respects to prevent infection of the kidney. The urethrashould be stretched carefully, so as not to cause needless dilatation and lossof power. The speculum should be introduced with relation to the curveof the arch of the i)ubis to avoid injury of the urethra. Careful introduc-tion of instruments into the ureter and kidney is urged to prevent perfora-tion of the former, and puncture of the latter, structure. The Remarks.—If fluid obscures the ureteral orifice, withdraw it bymeans of the evacuator (Fig. 1088). A catheter nuiy be kept in the ureterfor several hours, and even for three or four days in some cases. Flexibleinstruments are the safer for use. Catheters employed in the kidney shouldbe longer than those limited to the ureter. Wire stylets may be inserted ornot in either case, depending on the stilfness of the catheters and the needfor increased iiressure in the introduction. Metal catheters are used when. Fig. loss;.—The evacuator. the canal is constricted or tortuous. ^letal and hard-rubber bougies for dila-tation are serviceable in those cases. If a bougie (with the tip covered with 886 OPERATIVE SURGERY, dentists wax, Fig. 1085, h) be pressed against a stone in the nreter or kidneythe wax will bear evidence of the nature of the contact. The knee-breastposture is better than the elevated dorsal for stout patients. Kelly nses boro^lyceride solution to lubricate the instruments. Anelectric headlight (Fig. 103) is economic and advantageous in many frequently liap})ens that the most cautious use of these instruments is fol-lowed by bleeding from the ureter. In very nervous patients, and at a tirstexamination, general anesthesia may be required. A four-per-cent cocainsolution will deaden the sensibility of the urethra and bladder sufticientlyfor the purposes of the steps of the procedure. Catheterism of the ureters in the female is quite easily accomplish
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