On the operation for stone in the female bladder / by Alex. Ogston.

  • Ogston, Alexander, 1844-1929.
Date:
1879
Catalogue details

Licence: Public Domain Mark

Credit: On the operation for stone in the female bladder / by Alex. Ogston. Source: Wellcome Collection.

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    similar successful results in equally large stones. But experience is far from being unanimously in favour of either rapid dilatation or incision being always reliable, several series of cases resulting in incontinence of urine, blackening the otherwise good results. Per¬ sonally 1 have one bad result to record, in a patient of Dr Mitchell of Bayne, who had a uric acid stone, weighing 236 grains, measur¬ ing Itg inches (2*7 cm.) in the largest diameter that bore on the extraction, and 3 inches in smallest circumference. According to the experience of Bryant and Poland, it was proper to attempt the removal of such a calculus by rapid dilata¬ tion and extraction by the forceps, since the joint maximum dia¬ meter that had to traverse the urethra, including both the forceps and the stone, was 1TV inch, or, reckoning the most unfavourable grasp, lfV inches (3'3 cm.) At the time of that operation, June 1877, I had heard of Simon’s work, but did not possess his specula- dilators. I therefore selected rapid dilatation, and, to avoid the unequal stretching of Weiss’s three-bladed dilator, well known to and remarked on by many surgeons, dilatation was accomplished by the rapid successive introduction of rectum bougies after the meatus urinarius had been notched—an almost exact copying of Simon’s method. The urethra was dilated to the diameter of 11 inch (2 cm.), that is 2^- inches (6*3 cm.) in circumference, and the stone, whose circum¬ ference was 3 inches (7*7 cm.), or plus the forceps 3t36 inches (82 cm.), was extracted by carefully delivering it with the forceps. That is to say, the urethra was compelled to transmit a body measur¬ ing in circumference 3T3e inches, instead of the 2J inches (5*8 cm.) that can, according to Simon, be safely transmitted. Or, to put it otherwise, the diameter to which the urethra was dilated was 1 inch (2*5 cm.) instead of f inch (1*8 cm.), as it should have been. That extra quarter of an inch, which Simon declared unsafe, but which, according to others, should have been harmless, de¬ cided the fate of our patient. • To this day she has incontinence of urine, I am sorry to say. That was the smallest dilatation that I have heard of producing permanent incontinence, and it was the last case that 1 operated by the old method. I have since operated on four patients, two with calculi formed upon foreign bodies in the bladder, and two with ordinary calculi. From information gained in these cases it seems to me that it would be wise in future to adopt for calculus in the female some such plan of operation as the following :— When the patient is under chloroform, placed in the lithotomy position, and the presence of the stone has been confirmed by the sound in the bladder, and its size and. form roughly estimated by the bimanual exploration of one hand above the pubes and one or two fingers of the other in the vagina, the urethra should be dilated by Simon’s specula-dilators to its full size. Simon effects this by the following steps :—He notches the meatus urinarius at