Sarcoma of the bladder / by F.A. Southam.

  • Southam, Frederick Armitage, 1850-1927.
Date:
1888
Catalogue details

Licence: Public Domain Mark

Credit: Sarcoma of the bladder / by F.A. Southam. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    reach of the finger, and of moderate dimensions, or pedunculated, this can be effected through a perineal opening in males, or through the dilated urethra in females. In one case (male) the tumour was removed twice from the perineum, and in another (female) per urethram, without much difficulty. In all cases, however, and especially when the growths are multiple, sessile, and of large size, or if the perineum is deep and the patient stout, more complete access will be obtained through a supra-pubic opening. In one instance the growth was removed by supra-pubic cystotomy, after exploring the bladder from the perineum, its diffuse nature rendering its extirpation by the latter route impracticable. If on exploring the bladder, either from the perineum or from above the pubes, the growth, from its nature and connections,—e.g., if it is sessile and of firm consistence, extensively infiltrating the bladder-wall— is found to be not easily removable, or if its removal would be attended by danger, then it is a question whether it is not advisable to leave it, simply providing free bladder-drainage by establishing a urinary fistula on the same principle as in cases of cancer, namely, with the object of providing an outlet for the escape of urine, and in this way of relieving the pain and straining efforts which attend the frequent and ineffectual attempts at micturition. At the same time, by maintaining the bladder in a state of physiological rest, haemorrhage will be checked or diminished; while by frequently washing out the viscus with some antiseptic lotion, the inflammation of its walls can be relieved, and the offensive character of the urine, which when present, is in itself a source of irritation, can also be corrected. In one case, where on opening the viscus from above the pubes, a firm sessile growth was found involving its base and neck, no attempt was made at removal, the bladder being simply drained through the supra-pubic wound. Recurrence after Removal.—As regards the question of recurrence after removal, this is to be expected, especially when the growth is sessile and infiltrates the wall of the bladder, so that its complete extirpation is almost practically impossible. In one case, where, these conditions were present, evidences of a return of the growth were found at an interval of three months after operation, and it was again removed, death taking place about four months subsequently to the second operation. In another case, however, where a very diffuse growth was removed, nearly
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