BENIGN VESICAL GROWTHS SO SITUATED AS TO OBSTRUCT THE URETHRAL ORIFICE OF THE BLADDER.
Villous papillomatous growths of the bladder, which either fall upon the urethral orifice or grow around that outlet, differ from other benign growths of the bladder by provoking symptoms of vesical irritability and obstruction to the stream, prior to the orrhage. Such tumors number eight per cent. of all vinous papillo mata and have peculiar dangers attached to them.
Typical case.-A long-pedieled, Villous Papilloma Obstructing Urethral Orifice of Bladcler.—Mr. A. S., aged 24 (under Dr. Keser). He was blanched and breathless from loss of blood. He gave me the following account of his case : A year ago he was suddenly seized with a desire to pass water frequently. There was slight difficulty in doing so, but no pain. Blood appeared about a week later, and all symptoms subsided. In fourteen days' time he had a precisely similar attack and since then he has suffered for an entire year from irritability of the bladder and hmmaturia. He has been unable to hold his water for more than two hours unless in bed, from which he rises twice in the night. The first part of the stream is dark blood,
the midclle is clearer, and the last portion bright blood. The stream is slow, powerless, and thin. It shoots out at the commencement with some little force; then it stops abruptly, especially if he has re tained water longer than Asual. He has a slight aching in the right loin. Electric cystoscopy revealed a large papilloma, attached by a pedicle to the rim of the right ureteral orifice. Suprapubic cystotomy was immediately performed and the pedicle dissected out of its muscle bed, which latter was sound. Recovery followed.
The particular danger to which these corking growths expose the patient is septic pyelonephrosis arising from the tion. I have always found much residual urine, as well as evidence that backward renal pressure has been exerted on one or both kidneys in these cases. The cystoscopic examination entails washing, and if an operation is not immediately performed and the bladder drained, cystitis from introduction of organisms to the residual pool may take place and pyelitic and nephritic complication ensue.