A case of large secondary prostatic calculus, removed by perinæal incision / by T. Herbert Barker.

  • Barker, T. Herbert (Thomas Herbert), 1814-1865.
Date:
1847
Catalogue details

Licence: Public Domain Mark

Credit: A case of large secondary prostatic calculus, removed by perinæal incision / by T. Herbert Barker. Source: Wellcome Collection.

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    REMOVED RY PERIN^EAL INCISION. remove it masse, a lateral movement of the portions within view was had recourse to by means of the linger and thumb, lor the purpose of loosening them, and with little difficulty the pieces forming the anterior narrower part of the calculus were removed, and some of those constituting the posterior and broader portion were disintegrated. Having brought away several fragments with the lingers, others were grasped by the forceps and removed; but finding considerable difficulty in loosening three or four remaining portions, the left fore-finger was introduced into the rectum, for the purpose ol dislodging them from the prostatic part of the urethra, which being done, they were seized by the forceps and removed. The dislodgement of these last portions of the calculus was followed by the escape of a small quantity of urine. Having satisfied myself by careful examination that no calculi were left behind, the parts were sponged, three points of interrupted suture were introduced, the perinseum was covered with lint, and my patient put into bed. He was directed to have but spare diet. Ten p.m.—Comfortable; free from pain. A mild opiate draught was prescribed. 27th.—Free from pain, but sulfering some anxiety in conse¬ quence of the place '' having hurst;” urine had accumulated in the cavity which had been occupied by the calculus, and had at length escaped between the sutures. There is very slight tumefaction of the perinseum, and the oedema of the penis has somewhat subsided. The discharge from the original fistulous opening in the penis is very slight. An opiate at bed-time. 2^th.—The wound is going on very favourably; urine escapes through the lower end of the incision, liemoved the interrupted sutures. From this period to the next date he went on favourably, and the wound healed, with the exception of about half an inch of the lower extremity of the incision, through which the urine continued to fiow. November 13^A.—A catheter was introduced into the bladder^ through the entire length of the urethra, and secured in the usual manner. Two needles were introdueed through the parietes of the unhealed part of the incision, which were brought together as accurately as possible by the twisted suture. He was directed to remain in the supine position.