STONE IN THE FEMALE BLADDER.
Calculi in the female bladder arising, as in the male, simply from a deposit of the salts in the urine without other provocative cause, are but rarely found. Numerous cases, however, are recorded in which foreign bodies introduced by the patient herself through the urethra, or by a surgeon in the course of an operation, form the basis of calculi which may attain considerable size. All sorts of objects small enough to slip into the urethra have been thus introduced, and afterward found forming the nuclei of calculi. The commonest are catheters, pencils, and hair-pins. Of the latter a number of cases are recorded. The hairs of a dermoid cyst may also form the nucleus of a calculus.
An example of a hair-pin calculus is shown in Fig. 89. This was introduced by the patient, a young unmarried woman, who married a short time afterward. She passed through a confinement without any injury to the bladder, although the calculus had already formed about the pin and was felt by the doctor in attendance, who pushed it up into the abdomen while the head was descending through the pelvis. No explanation could be obtained from the patient as to how the hairpin got into the bladder, but the mother, who saw it after re moval, declared that she must have swallowed it.
I have twice removed calculi forming about sutures left in the septum after an operation for vesico-vaginal fistula. The peculiarity of these stones is that they are fixed.
The symptoms of vesical calculus are painful micturition and the various symptoms of the cystitis excited by its presence.
The diagnosis is made by inspection, when the calculus will be readily seen either lying free or pocketed in the bladder. It may also be recognized by the sound striking a hard body, and biman ually by catching the stone between the fingers in the vagina and the hand pressing down through the abdominal wall into the pelvis. All
methods of examination, however, are inferior to direct inspection after the manner described above.
The treatment of stone is by removal in one of the following ways: If it is quite small, not more than 2 to 2i cm. in diameter, or if it is somewhat larger than this, and quite soft, it may be crushed with a lithotriptor introduced into the bladder filled with water and with the pelvis elevated.
The old method of dilating the urethra and dragging out the stone ought never to be resorted to for the extraction of rough stones or those exceeding 1 to 2 cm. (1 to in.) in diameter.
Where the stone cannot be safely removed through the ure thra in the manner described, the best avenue of approach to it is by an incision into the base of the bladder in the median line in front of the cervix. This in cision can be made from an inch to an inch and a half long, the stone removed through it, and the incision immediately closed again.
Where the stone is so large as to fill the bladder, being 5 or 6 cm. (2 or 2i- in.) in diameter.,.
or even larger, and the patient is in good condition, it will often be better to remove it by a supra pubic operation, making an incision into the abdominal wall in the median line just above the symphysis, pushing up the peritoneum without opening it, incising the bladder, and removing the stone. If there is much cystitis, it will be better not to close the wound entirely, but to suture the bladder wound and insert a gauze drain above this in case of infection and breaking down of the incision.