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Operation for stone in the bladder.

The operation of cutting for stone in the bladder.

The operation by which a stone is extracted from the bladder. The different methods, according to which this operation may be practised, are reducible to five principal; each of which has experienced numerous modifications. 1. The Method of Celsus, Methodus Celsiana, Cystotomia cum apparatu parvo, Apparatus Minor, Cutting on the Gripe. This consisted in cutting upon the stone, after having made it project at the perinaeum by means of the fingers introduced into the rectum. This method was attended with several inconveniences; such as the difficulty of dividing the parts neatly, injury done to the bladder, as well as the impossibility of drawing down the stone in many persons. It is sometimes, also, called Methodus Guytoniana; from Guy de Chauliac having endeavoured to remove from it the discredit into which it had fallen in his time. It was termed Apparatus Minor, (F.) Le petit appareil, from the small number of instruments required in it. 2. Apparatus Major. This method was invented, in 1520, by John de Romani, a surgeon of Cremona, and communicated by him to Mariano-Santo-di-Barletta, whence it was long called Mariano's Method, Sectio Mariana. It was called, also. Apparatus Major, and Cystotomia seu Methodus cum apparatu magno, (F.) Le grand appareil, from the number of instruments required in it. An incision was made on the median line; but the neck of the bladder was not comprehended in it. It was merely dilated. The greater apparatus was liable to many inconveniences, such as ecchymoses; contusion; inflammation of the neck of the bladder; abscesses; urinary fistulae; incontinence of urine; impotence, etc. 3. The High Operation, Apparatus altus, Cystotomia cum apparatu alto, C. Hypogastrica, Epicystotomia, Laparocystotomia, Sectio seu Methodus Franconiana, S. Hypogastrica seu alta, (F.) Haut appareil, Taille Hypogastrique, Taille sus-pubienne, was first practised by Peter Franco, about the middle of the 16th century. It consisted in pushing the stone above the pubis by the fingers introduced into the rectum. Rousset afterwards proposed to make the bladder rise above the pubis by injecting it. The method had fallen into discredit, when Frere Come revived it. It is used when the calculus is very large. It was practised by opening first the membranous part of the urethra upon the catheter passed into the canal. Through this incision, the Sonde a dard- a species of catheter, having a spearpointed stilet-was introduced into the bladder. An incision was then made into the linea alba, above the symphysis pubis, of about four or five fingers' breadth, and the peritoneum detached to avoid wounding it. The stilet was pushed through the bladder, and used as a director for the knife, with which the bladder was divided anteriorly, as far as the neck; and the stone extracted. It was performed in England by Douglass, in 1719, and since by others, with various modifications. 4. The Lateral Operation, Hypocysteotomia, Cystotomia lateralis, Cystauchenotomia, Cystotrachelotomia, Urethrocystauchenotomia, Urethrocysteotrachelotomia, Sectio lateralis, Apparatus lateralis, (F.) Appareil lateralise, so named from the prostate gland and neck of the bladder being cut laterally, was probably invented by Peter Franco. It was introduced into France by Frere Jacques de Beaulieu. He performed it with rude instruments, invented by himself, and improved by the suggestions of some of the Parisian surgeons. In England, it received its earliest and most important improvements from the celebrated Cheselden. It is the method practised at the present day, according to different modes of procedure. In this method, the patient is placed upon a table; his legs and thighs are bent and separated; the hands being tied to the feet. The perinaeum is then shaved, and a staff is introduced into the bladder; the handle being turned towards the right groin of the patient. An oblique incision is now made from the raphe to the middle of a line drawn from the anus to the tuberosity of the ischium of the left side; and, taking the staff for a guide, the integuments, areolar tissue of the perinaeum, membranous portion of the urethra, transversus perinaei muscle, bulbo-cavernosus, some fibres of the levator ani, the prostate and neck of the bladder, are successively divided. For this latter part of the operation, the knife, the beaked bistoury, Bistouri ou Lithotome Cache, cutting gorget, etc., is used, according to the particular preference. The forceps are now introduced into the bladder, and the stone extracted. In the operation, care must be taken not to injure the rectum, or the great arterial vessels, distributed to the perinaeum. A variety of the Lateral Apparatus, called by the French Appareil lateral, consisted in cutting into the bas-fond of the bladder, without touching the neck of that organ; but it was soon abandoned, on account of its inconveniences. The method of Le Cat and of Pajola-Urethro-cysteo-aneurysmatotomia- consists in dividing the prostate in part only, - the enlargement of the wound being effected by a peculiar dilator. The Bilateral Operation is founded on that of Celsus. It consists in making an incision posterior to the bulb of the urethra, and anterior to the anus, involving both sides of the perinaeum by crossing the raphe at right angles: an incision is then made through the membranous part of the urethra, and the prostate may be cut bilaterally, either with the double lithotome of Dupuy tren, or the prostatic bisector of Dr. Stevens, of New York. 5. Lithotomy by the Rectum, Proctocystotomia, Sectio recto-vesicalis, (F.) Taille par la Rectum. Taille posterieure, T. Recto-vesicale. This wag proposed by Vegetius in the 16th century; but it was never noticed until M. Sanson, in the year 1817, attracted attention to it; since which time it has been successfully performed in many instances. It consists in penetrating the bladder through the paries corresponding with the rectum, by first cutting the spinchter ani and rectum about the root of the penis, and penetrating the bladder by the neck of that organ, dividing the prostate,-or by its bas-fond. Lithotomy in women, from the shortness of the urethra, is a comparatively insignificant operation.

Removal of stone by cutting into the bladder.

Syn.: cystotomy. The removal of a stone by cutting into the bladder.

n. [Greek] The operation, art, or practice of cutting for the stone in the bladder.