BLADDER, Diseases of. These may be classed as malformations, injuries and diseases proper. Occasionally the intestines and ureters enter a common pouch, cloaca, as in certain lower animals. Rarely the bladder is absent entirely. One of the most frequent malfor mations is exstrophy, in which there is no front wall to the bladder, it opening directly, from failure of the anterior abdominal wall to close. The hind wall of the protruding blad der becomes red and irritated and inflamed. The treatment is exclusively surgical, save when the exstrophy is slight or incomplete, when certain types of apparatus may be found efficient. Diverticulum of the bladder is an other form of malformation. Here small sacculations are present, which, usually filling with residual unne, give rise to a cystitis. Hernia of the bladder consists in a displace ment which may be 'congenital or acquired. It may occur at the site of other ruptures of the body, chiefly inguinal in man, and vaginal or femoral in women. Cystitis is the chief danger here as well and the treatment is surgical. Wounds of the bladder are infrequent save in war times when they are apt to be extremely prevalent and usually complicated by splintered wounds of the pelvis. Infection is less apt to occur and most punctured wounds of the blad der are readily treated surgically. Rupture of the bladder usually results from severe crush ing accidents. Occasionally, in the diseased bladder, the pressure of retained urine may cause rupture; rarely this occurs during labor. The initial symptoms are usually as if some thing gave way on the inside. If the bladder has been greatly distended there may be a momentary feeling of relief. Pain in the whole abdominal cavity soon develops. Shock is added, the patient is prostrated and unable to walk. Treatment by surgical means is impera tive.
Tumors of the bladder are frequent. They are papilloma, carcinoma, myoma, fibroma and sarcoma. These tumors are usually accom panied by intermittent bloody urination and by pain. Cystitis develops and even non-malig
nant tumors — i.e., those other than sarcoma or carcinoma,— may cause death from the changes which follow the cystitis, pus kidneys, etc. Exact diagnosis of tumors of the bladder can usually be made by the use of the cystoscope, an instrument permitting an inspection of the interior of the bladder. Cancer of the bladder is usually accompanied by severe pains. Surgi cal treatment is alone available for tumors of the bladder. The non-malignant tumors may exist for many years and give rise to but slight inconvenience. The malignant tumors, chiefly cancer, are fatal within a few years unless diagnosed early and properly treated.
Cystitis is the name given to an inflamma tion of the lining membrane of the bladder. The mucous membrane of the bladder is highly resistant to infection, hence a cystitis here is frequently something more than a mere in fection of the bladder itself. The chief cause for a cystitis is gonorrhea. This is to be re [carded as an extension from the urethra. It is rare save in the predisposed bladder, hence certain authors speak of the rarity of a gon orrheal cystitis. While this may be a technical distinction made by the specialist, for practical purposes, a gonorrheal cystitis is a cystitis.
The chief early symptom of a cystitis is the increased frequency of the desire to urinate. This may be slight or it may consist of a per sistent painful urge which accomplishes with agony the passage of but a few drops of urine. Pain may be slight, save in the more marked cases, when it may be severe and persistent. It is felt just behind the pubic bone, or in the perineum, shooting down the thighs, to the testicles, and down the penis. Pain in the neck of the bladder is specially referred to the per ineum and the end of the penis. In most cases there is some fever, and constipation is the rule. Pus is found in the urine which latter is frequently alkaline in reaction.