The exploration of the urethra and bladder / by M. Tuchmann.

  • Tuchmann, M. (Maro)
Date:
1899
Catalogue details

Licence: Public Domain Mark

Credit: The exploration of the urethra and bladder / by M. Tuchmann. Source: Wellcome Collection.

    34/108 (page 20)
    If now, with the instrument held firmly in its present position, the bladder is opened, we can see what causes the obstruction : as the ureteric ridge is unsymmetrical, and is more towards the right side, the left ureteric valve, being longer, lies nearer the middle line than the right valve. The instrument is pushed against the left valve, and if more force is used, the beak is driven under the loosely attached valve pushing it backwards, and may even tear it (fig. lO). In order to avoid the left valve, and to produce the same sensa- tion of jolting over a rough surface we experienced with the beak turned to the right, which informed us we were passing over the interureteric ligament, we must alter the position of the beak: first withdrawing it a little we bring the shaft over to the left (fig. lo), thus moving the beak in the bladder to the right. Now, avoiding the left valve, it will be easy to pass the point of the instrument over the left half of the ureteric ridge, and to reach the post-trigonal region and the posterior boundary of the fundus. If on the dead subject we notice the parts passed over, when the beak of our instrument is investigating the left and right half of the fundus, we can find out how it is that we experience a diflferent sensation on either side. We see that it is only the central part of the ureteric ridge, viz., the interureteric ligament which, being firmly attached to the underlying tissues, allows the instrument to pass over it; it may arrest the movement of the beak a little, but after a momentary stoppage the beak glides further down. We find it is otherwise with the lateral portions of the ureteric ridge: these portions, the valves, owing to their prominence and their loose attachment, prevent the beak from being moved further, provided the shaft is sufficiently raised, and the beak kept in close contact with the fundus. It is usually the left valve with which we come in contact, but if the beak touches the right valve, we find it as prominent, as loosely fixed, and as obstructive to the progress of the instrument as the left valve. On both sides we have to lower the shaft a little so that the beak is a little raised, and brought away from the fundus; only in this way can we pass over the valves, and the jolting movement is less distinct than when we crossed over the interureteric ligament. Thus, since on either half of the fundus it is immediately to the outside of the ureteric opening that the beak is arrested by the ureteric valve, and just to the inside of the opening the beak moves with a distinct jerk over the ureteric ridge, we are able, before the body and bladder are opened, to find out the exact position and length of the ureteric ridge, of the interureteric ligament and of the ureteric valves. We are thereby further enabled to ascertain, be- fore the body is opened, that in most cases the interureteric ligament is unsymmetrical, as it is drawn over more to the right; in some bodies it is quite symmetrical, and in exceptional cases it is drag- ged more to the left. The above statements are denied by G. Simon, who contends that the ridge cannot be made out with the catheter, but I may add that Civiale,'''' DitteF and others have noted the fact that, in