The paralytic retention of urine may be caused by an injury to some part of the spinal marrow ; by an over distention of the bladder, arising from retaining the water too long after an inclination is felt to void it, &c. Two objects are to be ac complished in the treatment ; to draw off the fluid distending the bladder, and to restore the natural contractile power of the viscus. The use of the catheter at certain stated periods accomplishes the first of these; the internal use of cantha rides, blisters to the sacrum, pubes, or perineum, cold water thrown on the by pogastrium, cold bath, &c. promote the second indication. The catheter must be used regularly and frequently, until the cure is completed.
The retention arising from enlarge ment of the prostate belongs to this divi sion. A neglect of the patient to obey the natural calls to void his urine is the first cause ; and the regular use of the catheter is the most efficacious means of cure.
Use of the catheter. This instrument is either inflexible, and made of silver, or flexible and elastic, which is composed of the elastic gum. There are also flexible catheters made a of fusible metal, and others composed of the boogie plaster; but the former are employed the most frequently. The elastic catheter is less irritating to the urethra than a silver tube, and it can be introduced in cases where a metallic inflexible instrument will not pass. The most favourable posture for the introduction of the catheter, is that in which the patient lies down, with his pel vis at the edge of the bed, and the legs hanging to the ground. The corona glan dis should be held between the thumb and fore-finger of the left hand, so as to avoid compressing the corona glandia. The catheter, well oiled, should be intro duced, with the concavity towards the abdomen, until its point has nearly reach. ed the bulb. The handle should now be brought slowly forwards, between the pa tient's thighs; and the point will conse quently describe that portion of a circle which is necessary for its entering the bladder. In the latter stage of the opera tion, the penis, which before had been drawn upwards, should be allowed to sink down. If an impediment is met with in any direction, let the point be with drawn a little and then pushed gently onwards, according to the course of the urethra ; but force should be avoided by all means. The fore-finger of the left hand, introduced into the rectum, will sometimes facilitate the operation. When
the prostate gland is enlarged, the ure thra turns upwards very suddenly, just behind the pubes ; hence the end of the catheter should be more bent upwards. It has also been found that, by withdraw ing the stilet of an elastic gum catheter for a small distance, the instrument itself becomes more curved ; and by this means the point of the instrument may be ele vated in the urethra in the due direction. Many surgeons introduce the catheter as far as the perineum, with its convexity towards the abdomen ; then keeping the point stationary, they make the handle describe a semicircular movement up wards, so as to bring the concavity of the instrument towards the pubes; after which the operation is finished as in the former method.
When the retention of urine arises from an inflammatory cause, the nature of the disorder is entirely altered. Strictures in the urethra, when very bad, and irri. tated so as to fall into spasmodic contrac tion, are the most frequent source of this kind of retention. However, virulent gonorrhoea, bad piles, injuries of the pe rineum, fistula in ano, and the absorption of cantharidea from blisters, may have the same effect. The treatment of such cases must be of the antiphlogistic kind ; vene section, leeches to the perineum, warm baths, fomentations to the perineum and hypogastric region ; opium by the mouth, and in clysters, are consequently to be employed. The use of the tinctura fern muriati internally is also a very powerful assistant in such affections. The patient may take fifteen drops every ten minutes until it acts. A common clyater will of ten suffice in slight cases.
If none of these methods succeed, and the catheter or bougie cannot be intro duced, it becomes necessary to puncture the bladder ; which operation is neither dangerous nor painful, and fails in success, probably, because it is employed ly too late. It may be done the pe rineum, pubes, or rectum. The two lat ter places are so much preferable to the former, that we shall describe those ope rations only. When the prostate glandis enlarged, (and such a case often requires the paracentesis vesice) the operation must be done above the pubes ; if the pa tient should be fat, it would be preferable to puncture from the rectum. When all circumstances are equal, experience has not hitherto discovered any very decisive advantage in either of these methods over the other.