Modern surgery, general and operative . Nelatons catheter. and quinin to asepticize the urine. In some few cases no instrument can beinserted in the bladder. In most of such cases aspirate—which may be doneseveral times if necessary—and in a day or two, when swelling and congestionabate, an instrument can be passed. The parts are asepticized. A smallaseptic trocar or aspirator needle is pushed into the bladder, the trocar orneedle being inserted in the median line, just above the pubes, and taking acourse downward and backward. After the completion of the operation thepimcture is dressed with
Modern surgery, general and operative . Nelatons catheter. and quinin to asepticize the urine. In some few cases no instrument can beinserted in the bladder. In most of such cases aspirate—which may be doneseveral times if necessary—and in a day or two, when swelling and congestionabate, an instrument can be passed. The parts are asepticized. A smallaseptic trocar or aspirator needle is pushed into the bladder, the trocar orneedle being inserted in the median line, just above the pubes, and taking acourse downward and backward. After the completion of the operation thepimcture is dressed with iodoform and collodion. Only half the urine is with-. Phillipss catheter. drawn at a first aspiration. Rectal puncture is now obsolete. If incision isnecessary in retention, the perineal route is usually chosen. In some cases theoperation is done with, in some without, a guide. In prostatic retention notrehevable by a catheter, make suprapubic drainage or do prostatectomy. Congenital Defects of the Bladder.—Exstrophy of the bladder(ectopia vesicce) is a condition of defective development commoner in malesthan in females. The anterior abdominal wall has failed to close, the ante-rior wall of the bladder is absent, the arch of the pubes has not developed, 1316 Diseases and Injuries of the Genito-urinary Organs epispadias exists, and in many cases the testicles have not descended intothe scrotum. In this condition the posterior wall of the bladder projectsinto or beyond the gap in the abdominal wall; the urine constantly flows andrenders the condition of the patient dreadful. The condition shortens lifeand only 30 per cent, of the victims
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