. Modern surgery, general and operative. Fig. 964.^Nelatons catheter. Strengthened by having a filiform passed in its lumen nearly to the beak, andthe rat-tailed silk instrument. In enlargement of both lobes and the middlelobe try the coude, then the bicoude, then a coude and a bicoude with olivaryor rat-tailed tips. If all of these fail, the overcurved metal catheter of Brodiemust be used gently. In retention from expulsive defect use a soft catheter(Fig. 964). Cases of retention after catheterization require warmth, confine-ment to bed, the administration of laxatives, free action of the .sk
. Modern surgery, general and operative. Fig. 964.^Nelatons catheter. Strengthened by having a filiform passed in its lumen nearly to the beak, andthe rat-tailed silk instrument. In enlargement of both lobes and the middlelobe try the coude, then the bicoude, then a coude and a bicoude with olivaryor rat-tailed tips. If all of these fail, the overcurved metal catheter of Brodiemust be used gently. In retention from expulsive defect use a soft catheter(Fig. 964). Cases of retention after catheterization require warmth, confine-ment to bed, the administration of laxatives, free action of the .skin, and the useof such drugs as salol, boric acid, urotropin, and quinin to asepticize the Fig. 965.—Phillipss catheter. In some few cases no instrument can be inserted in the bladder. In most ofsuch cases aspirate—which may be done several times if necessary—and in a dayor two, when swelUng and congestion abate, an instrument can be passed. Theparts are asepticized, A small aseptic trocar or aspirator needle is pushed intothe bladder, the trocar or needle being inserted in the median line, just above thepubes, and taking a course downward and backward. After the completionof the operation the puncture is dressed \vith iodoform and collodion. Onlyhalf the urine is withdrawn at a first aspiration. Rectal puncture is now 1462 Diseases and Injuries of the Cienito-urinary Organs obsolete. If incision he necessary in retention, the perineal route is usuallychosen. In some cases the operation is clone with, in some without, a guide. Inprostatic retention not relievable by a catheter, make suprapubic drainage or doprostatectomy. Congenital Defects of the Bladder. Exstrophy o
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