Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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FiG. 169.—Bladder Phantom. MALFORMATIONS OF THE BLADDER 293 duced; free bleeding from the posterior urethra, bladder, or ureters; dis-placed or obscured ureteral openings; vesical tumors, or intravesical pros-tatic lobes; strictured urethra, strictured ureters or those obstructed bycalculi; precipitate bladder or deep bas fond, as indicated in Fig. 170,are some of the causes of difficulty in connection with cystoscopy orcatheterization. If it is found that sufficient local anesthesia is notattainable by the method already advised, general anesthesia may beemployed or spinal anesthesia may be substituted, three-fourths to one-half grain of alypin being injected into the subarachnoid space for thatpurpose. All difficulties must be met with intelligent appreciation andappropriate action as they are encountered.
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Fig. 170.—Precipitate Bladder; Ureters Inaccessible to Direct Method of Catheteriza-tion; Indirect Method in Use. MALFORMATIONS OF THE BLADDER. Absence of the Bladder.—In certain individuals the bladder iscongenitally absent, the ureters then opening into the urethra, the vagina,or the rectum. This condition is rare. Its indications for correctionare largely met by the wearing of a rubber urinal; but there is little pros-pect of reclamation to the normal by operative measures, as in such in-stances the accompanying malformations are so great as to dwarf theurgency of relief from this condition. Supernumerary or multiple bladder is another rare congenitalanomaly. It is sometimes confused with congenital diverticula of the organ.Supernumerary bladder occurs in connection with reduplication of otherpelvic organs, such as double penis, vagina, etc., and is but a phase ofgeneral congenital anomaly. It requires no especial operative attention. Diverticula or sacculations of the bladder

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