CANCER OF THE BLADDER.—The malignant growths in the female bladder or the villous type of organism which is liable to take on cancerous action may he removed under Chloroform by dilating fully the urethra and thoroughly curetting the tumour, whose base should be then freely cauterised.
The male patient should be placed in the high Trendelenburg position as recommended by Mayo, and after a free median incision the intestinal cavity and lips of the wound are protected by gauze pads in order to prevent the possibility of transplantation of cancer cells. The bladder being brought forward by tenaculum forceps is opened by a moderate incision, all urine withdrawn and sponged out, and the growth excised with the entire thickness of the bladder wall when this has been found infiltrated, and the gap is then closed by a double row of catgut sutures. Where the tumour is superficial in extent it may be cut out along with its underlying healthy submucous layer by scissors, and the resulting raw surface thoroughly cauterised. Large portions of the bladder may be removed, and one or both ureters may be implanted into the fundus of the organ when their orifices or the neighbouring region is involved.
Complete cystectomy has been performed by Fenwick and others with success, the ureters having been dealt with by a previous operation which enables their lower extremities to be brought out and fixed by a small incision in the iliac region. In the female the ureters may be transplanted (previous to removal of the bladder) into the vagina, which can he after wards closed so as to constitute a new vesical cavity.
In unremovable cancer of the bladder much relief has been obtained and the prolongation of life maintained under comparatively comfortable conditions by a bilateral ureterostomy which drains the kidneys through the loins or in the iliac region.
Where the patient is unable to bear the shock of a serious operation, catheterisation and the use of local or constitutional anodynes, or free drainage of the bladder by a small perineal or suprapuhic incision, may he resorted to.