WOMEN - NEOPLASMS.
Cancer of the bladder is often observed through extension of the disease from the cervix uteri, but primary new growths of the blad der walls are rare.
The relative frequency of tumors in the male and female affecting the bladder walls primarily has been estimated in the proportion of three to one.
Williams (British Medical Journal, 1889) found, out of 90 cases of tumor of the bladder, of which 20 were in women, 16 were carcino mata, 2 papillomata, 1 sarcoma, and 1 fibroma.
The name papilloma is often made to include both benign fibrous growths covered with epithelium more or less branched in form, and growths which show their malignant nature by relapsing into carci nomata or sarcomata.
True papilloma, " dendritic fibroma," appears to originate from a budding of the vesical blood-vessels.
Golding-Bird (British Journal, 1889) describes a case of sarcoma originating in the posterior walls of the bladder, re moved by suprapubic section with the galvano-caustic loop. The wound was drained by carbolized gauze. The patient died on the fourth day, with infection.
The most characteristic symptom of bladder tumors in the early stages is hemorrhage.
The diagnosis is easily made upon inspection with the cystoscope.
The treatment will vary according to the nature and size of the tumor. Small pedunculated tumors can be easily caught with a snare like that used for removing nasal polypi. They may be slowly re moved in this way, taking several hours if the operator deem it wise on account of the danger of hemorrhage. The patient is returned to bed after the loop of the snare has been placed about the pedicle; the screw is turned to tighten it up every ten or fifteen minutes until the pedicle is cut through. Larger tumors may be removed by vagi nal incision in the same manner as vesical calculi. The base may be ligated or closed by sutures, which will afterward be removed through the cystoscope.
Malignant tumors, unless limited in extent and so situated on the base of the bladder as to be readily reached through the vagina, ought to be removed by preference by suprapubic section, through which larger areas of the bladder wall can be extirpated with more precision, and the incised edges brought satisfactorily together.
Professor Pawlik, of Prague (Centralblatt fir Gyaileologie, 1890, page 113), removed a small pedunculated polypus from the bladder by a vaginal incision. Eight mouths later the hemorrhages had returned, and an examination revealed an extensive, broad-based papilloma, for which he proceeded to extirpate the bladder. After introducing two metal catheters into the ureters, he freed the terminal extremity of each ureter for 2 cm., and attached it to the vaginal wall, establish ing two uretero-vaginal fistulae. Three weeks later he extirpated the bladder by making a suprapubic incision, without opening the peri toneum, and released the bladder from its attachments. The vaginal wall was then cut transversely, just beyond the urethral prominence, and the bladder drawn through this opening into the vagina and cut off at the internal urethral orifice. An attempt was now made to close the vagina by turning the urethra into it and making a pocket for the urine escaping from the ureters, by uniting the upper margin of the vaginal incision to the anterior urethral wall and closing the vagina below this by a circular denudation and suture. The new bladder formed in this way had a capacity of 400 c.c. The closure of the vagina, however, was not successful.
The most important summary of the literature of this subject will be found in the Jahresberichte of Professor Frommel, of Erlangen.