Transvesical prostatectomy in two stages : with remarks upon the pathology and clinical phases of prostatic obstruction / by Paul Monroe Pilcher.

  • Pilcher, Paul M. (Paul Monroe), 1876-1917.
Date:
[1914], ©1914
Catalogue details

Licence: Public Domain Mark

Credit: Transvesical prostatectomy in two stages : with remarks upon the pathology and clinical phases of prostatic obstruction / by Paul Monroe Pilcher. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    73/82 (page 65)
    cautery or the high-frequency spark generated from the D'Arsonval current. In one case of my own, it was necessary after the second week to re-open the bladder widely and cauter- ize the entire area of the vesical neck before the hemorrhage could be stopped. Drainage of the Bladder After Transvesical Prostatectomy. —To the mind of the writer, it is very essential to drain the bladder suprapubically after every case of prostatectomy. We consider it dangerous and unnecessary to run the risk of closing the bladder after transvesical prostatectomy. This has been emphasized in our own experience in two cases in which we closed the bladder and were compelled to re-open and drain the bladder on account of severe hemorrhage within the bladder which clogged the urethral catheter. Our routine is, as soon as the prostate is removed and the hemorrhage checked, to introduce a large rubber drainage tube, one inch in diameter, just within the wall of the bladder, and after securing it in place to apply copious gauze dressings over the same. If the packing of the prostatic pouch is necessary, a small gauze pack- ing is brought out through the large drainage tube. It should be emphasized at this point that none of the silk skin sutures introduced at the primary operation have been removed, and that after the enucleation of the prostate no suturing of the wound is necessary. The cystostomy wound made at the first operation is capable of very great distention without tearing it open if the original sutures have not been removed. After-treatment.—As soon as the patient has been returned to his bed a proctoclysis of tap water is begun and the abdominal dressings changed as frequently as necessary. After 24 hours the bladder is irrigated through the suprapubic tube which is still in place. If packing is in place it is removed, together with the large suprapubic drainage tube. The Pezzer catheter replaces the suprapubic drainage tube. It will be found that in six to eight hours the bladder wall will contract around the Pezzer catheter and very little urine will leak out beside it. The Pezzer catheter is left in place for three or four days until the wound surfaces have healed over. This tends to pre-