The after-treatment consists in rest for a few days in bed. When pain is severe a Morphia suppository should be inserted into the rectum, which should have been thoroughly cleared out before the crushing, and when retention of urine occurs a sterilised catheter must be passed three times a day till the bladder regains its tone.
The lithotrity instruments require a urethral capacity of 16 to 20 (English). and often some gradual preliminary- dilatation of the canal, or division of a tight external meatus, may be necessary. Where a hard stricture exists, lithotrity may be still advantageously performed by resorting to Keith's perineal operation, which may also be selected in the case of the largest stones: Suprapubic lithotomy is the ideal operation for stone when enlargement of the prostate complicates the Lase, as the prostatic tumour can be then removed after the extraction of the calculus, in which cases the after treatment is to be carried out on the lines detailed under Prostate. If the operation is undertaken simply for the removal of a large stone, after this has been delivered by the scoop or lithotomy forceps the bladder and upper part of the skin wound should be closed up with sutures, provided the urine is aseptic. In septic cases a catheter must be tied in, and this should be connected with a suction apparatus or else drainage may be employed through the perineum. Before making the abdominal incision,
the bladder should be washed out with warm Boric Acid solution, and a quantity of this should be retained sufficient to distend the organ till it is felt by the hand as a distinct tumour above the pubes. In order to insure this distension during the time when the cutting operation is being carried out it will be necessary for an assistant to grasp the penis firmly, or a piece of rubber tubing may be tied round it to prevent the escape of the liquid. Most operators now dispense with the introduction of a rubber tube inserted into the bladder through the abdominal wound. Subsequent suture of the bladder is greatly facilitated by the Trendelenburg position.
Stone in the female bladder is as a rule easily removable under a general anesthetic through the dilated urethra. if very large it may be crushed by the lithotrite, or if soft and friable it may be broken up by the blades of a stout dressing or necrosis forceps. Very large stones may be extracted through the suprapubic route; the incision of the vagina is now abandoned owing to the danger of the establishment of a permanent vesico-vaginal fistula.