Pesquisando por: "Cystoscope" - Fotoarena - Agência de fotojornalismo

2X043CK Ureteral stent. Renal colic. Human Urinary System. cross section of a kidney and bladder with pig-tail stent. vector illustration isolated on white ba

2KA50GY A surgical urethroscope in the hands of a doctor

2H850BW Closeup Image Of Urological Surgical Scope Flexible Ureteroscope In The Sterilization Tray. Selective Focus

2RF97ME Laser surgery for treatment of benign prostatic hyperplasia, endoscopic image.

2RF97M6 Laser surgery for the treatment of benign prostatic hyperplasia.

2RF97M8 Laser surgery for benign prostatic hypertrophy treatment, endoscopy image.

2RF97KK Laser surgery for treatment of benign prostatic hyperplasia, endoscopic image.

WHW2A9 The illustrate explain cause of backache and abdomen pain from ureter blockage, affecting to the nerves. 3D Illustration anatomy human body.

2F1W1F7 Medical Surgical Rigid Laparoscope On Sterilization Tray

RM83P1 Cystoscopy of the bladder 3d vector illustration on white background

M7AF6J Bladder cancer is any of several types of cancer arising from the tissues of the urinary bladder. Info graphic vector.

G5X6W8 Nitze, Maximilian, 18.9.1848 - 23.2.1906, German medic / physician, portrait, circa 1900,

BY7WNM A urologist performing a cystoscopy in order to remove a foreign body from the bladder (in this case a radioactive implant).

BY7WN6 A urologist performing a cystoscopy in order to remove a foreign body from the bladder (in this case a radioactive implant).

CT6A8F PROSTATE LASER SURGERY

CT6A7J PROSTATE LASER SURGERY

CT6A6K ENDOSCOPIC SURGERY

CT6A42 ENDOSCOPIC SURGERY

CT6A2D SURGICAL EQUIPMENT

CT6A1R PROSTATE LASER SURGERY

CT6A18 PROSTATE LASER SURGERY

CT6A0K PROSTATE LASER SURGERY

2WWW5PA cystoscope urology glyph icon vector illustration

2WWW2TK cystoscope urology line icon vector illustration

2WWW18F cystoscope urology color icon vector illustration

2GH4EHP Cystitis. Inflammation of the bladder. The structure of the kidneys and bladder. Excretory system. Infographics. Vector illustration on isolated

2F7MPYG Cystitis. Inflammation of the bladder. The structure of the kidneys and bladder. Excretory system. Infographics. Vector illustration.

2CRRKFP . Journal of radiology . using much distress to the patient and with prop-er attention to aseptic and antiseptic measures the dangerof inflammatory complications seems very small. 2. The procedure renders it possible to thoroughly vis-ualize the peritoneum, parietal and visceral and pathologyin structures beneath the peritoneum may show findingshelpful in diagnosis. 3. A training in the use of the cystoscope and a knowl-edge of the appearance of normal abdominal viscera afterpneumoperitoneum has been produced in the a>ray fluoro-escent screen are very helpful qualifications for beginningper

2CRRDJN . Radium . Fig. 2.—Shows a (llagraniatic cystoscopic pitture ot the radium needlesinserted into a tumor mass. The technique of application of the new device differs but littlefrom that employed in connection with the various cystoscopic operat-ing instruments, the only different feature being that the radium deviceis too large to be passed through the cystoscope while the optical tube isin position. For that reason, following the iii-igation of the bladderthrough the irrigating sheath, the radium instrument must first be passedthrough the irrigating sheath and guided out of the cystoscope into

2CRRDK6 . Radium . shown by examining withthe finger in the rectum and cystoscope in the urethra a markeod increasein the suburethral portion of the prostate, not merely in the presper-matic or subcervical group of glands, but also beneath the entire pros-tatic urethra from the vesical orifice to the apex, and this increase inthe suburethral portion of the prostate is usually associated with markedinduration. This is based on the pathological fact that prostatic hyper-trophy almost never involves the so-called posterior lobe which lies be-tween the posterior capsule and the ejaculator- ducts above an

2CRRDMA . Radium . Fig. 3.—Shows diagramalicalbthe radium needles inserted intothe tun>or mass.. Fig. 4.—A shows the flexible metal shaft employed to guide the radiumdevice out of the cystoscope into the bladder. B, the Brown-Buerger operat-ing cystoscope with the radium device in position. I^AOIUM 43 TECHNIQUE OF RADIUM TREATMENT OF CANCEROF THE PROSTATE AND SEMINAL VESICLES* By Hugh H. Young, M.D., F.A.C.S., BaltimoreFrom the James Buchanan Brady Urological Institute, Johns Hopkins Hospital At the International Medical Congress, London, 1913, in the Sec-tion of Urology, Pasteau and Degrais presen

2CRRDJR . Radium . Fig. 1.—Shows radium needles (also employed for internal radiation ofcarcinoma of the prostate), screwed into the metal block mounted on theflexible shaft. Radium 41 needles which contain amounts of radium up to 15 milligrams; the sametype of needle as employed in the internal radiation of carcinoma of theprostate, so that the needles employed for one may be employed forthe other purpose. The device constitutes a small fork which may beplunged into the tumor mass through the Brown-Beurger operatingcystoscope (Fig. 2 and Fig. 3), and the cystoscope fixed by the em-ployment of a mecha

2CRRDMM . Radium . nby surface applications, the device here described has been made andsatisfactorily employed in the treatment of malignant tumors of the uri-nar bladder. AVith the exception of a special device to implant radiumemanation into tumors of the bladder all other instruments employedfor radium treatment of malignant tumors of the urinary bladder, by wayof the urethra, have been employed for the purpose of applying radiumto the surface of the tumor mass rather than within its substance. In developing the present instrument there has been a desire to avoidmaking a special cystoscope for th

2CRRCEX . Radium . ac-complished. He first secured pieces of tumor for microsopic examina-tion, and if the tissue proved to be cancerous, he did not attempt its re-moval endovesically. If, however, the tumor was not cancerous, he re-moved it by this means. The percentage of tumors which he was ableto remove through his operating cystoscope and his end results com-pare almost identically with results obtained by the methods employed I^ADIUM 8i) today. Apparently the type of tumor which we can today remove bymeans of fulguration he succeeded in destroying by means of his ingen-ious cauteries and wire sn

2CRRCF0 . Radium . o radiation and disappeared with varyingamounts of treatment, depending upon the size of the tumor. Technique. By means of a special cystoscope 100 milligrams ofradium were carried into the bladder which was previously distendedwith fluid, and then under direct vision the radium was placed againstthe tumor mass. It was usually left in position for one hour and thetreatment was repeated about every second or third day. The frequencyand the period of duration of any one treatment naturally varied some- I^ADIUM 93 what with the tolerance of the individual. This accurate placing of ther

2CRPRRJ . Journal of roentgenology . No. 3176. ILLUSTRATION IS AN ANTEROPOSTERIOR VIEW.PATIENT LYING FACE UPWARD, BUT HIPS ELEVATED,i. e. THE TRENDELENBERG POSITION Rays are directed at right angle to the long axis of patient. A pneumo-peritoneum has been produced, as well as a pneumocystoma or air distendedbladder. The bladder wall can be observed to be of uniform diameter and uniformdensity throughout the portion shown in this position. The illustration shows the catheterizing cystoscope inserted through whichthe oxygen was introduced. 284 THE JOURNAL OF ROENTGENOLOGY. No. 3177. ILLUSTBATION IS AN A

2CRP7WK . The American journal of roentgenology, radium therapy and nuclear medicine . which we did not, the diagnosis was estab-lished only at the expense of much time andtrouble and considerable punishment of theunfortunate patient. Positive diagnosis ofrenal calculus was not possible until the ad-vent of the .r-ray. Intolerant and bleeding bla.dders and ure-thral obstructions often have defeated us,even in the use of the cystoscope. Not infre-quently, stones have been overlooked by thecystoscopist. Where the A-ray is available,an accurate diagnosis nowadays is almostalways possible, if the roentgen

2CRKWGW . Röntgen ray diagnosis and therapy . far as the diagnosis of the number, shape, and position of vesi-cal calculi is concerned, the Eontgen rays afford a more valuablemeans than the cystoscope. The time of exposure should be aboutthree minutes. A tube of medium hardness is best. Foreign bodies, such as hair-pins and similar objects, whichentered the bladder by the urethral route, must be frequentlylooked for by skiagraphic examination. They are soon surroundedby incrustations which make their recognition so much easier. In children the representation of vesical calculi is especiallyeasy, an ex

2CRK0HK . Electricity : its medical and surgical applications, including radiotherapy and phototherapy . Belfields ureter catheterization and diagnostic male cystoscope. Cystoscope.—The cystoscope is a valuable aid in determining thenature of obscure affections of the bladder. It may also aid us in someaffections of the kidneys, as by its use we may either determine theappearance of the stream of urine from each kidney, or by catheterizingthe ureters collect the urine from each kidney for examination. Variousforms of the instrument have been devised; one is shown in Fig. 124, 1 Transactions American E

2CRK00T . Electricity : its medical and surgical applications, including radiotherapy and phototherapy . Howard A Kellys female cystoscope.. Bransford Lewis operating cystoscope. Endoscope.—The endoscope or urethroscope is employed to obtain avisual examination of the mucous membrane of the urethra, and mayalso be used in the treatment of localized areas of inflammation, erosions,infiltration, and inflammation about the urethral follicles, granularpatches, papillomata, and polypi. Such treatment can only be carriedout })y the aid of this instrument, the lesion being first exposed by it THE ELECTRIC LI

2CHW6F5 . The diagnosis of diseases of women . Glass tube with rubber catheter. With the exception of the field near the sphincter vesicae, the veinsare rarely seen in the normal bladder. From a clinical point of view the most important parts of thebladder are the trigone and base. It is here that foreign bodies andpathological lesions are most often observed. The trigone presentsa smooth, glistening surface, varying in color from gray to dark red,and contains a close network of capillaries. Fig. 200. Urethral dilator. As the cystoscope is slowly introduced the first image to greetthe eye is that of t

2CHTMC8 . The diagnosis of diseases of women . Hand holding cystoscope in act of introduction. (Kelly.) DIAGNOSIS OF DISEASES OF URETHRA AND BLADDER 507 genitals and vagina are cleansed the patient is enveloped in sterilesheets, the urine is withdrawn from the bladder, the urethra isdilated to the necessary size, and a speculum containing its obtur-ator introduced into the urethra. By means of a crank the top ofthe table is turned on a transverse axis so that the lower end iselevated and the upper end depressed. The patient is thus made Fig. 214. Knee-breast position. Cystoscope introduced; sound show

2CHTH8C . The diagnosis of diseases of women . size of the speculum shouldvary from No. 7 to No. 12, according to the case. When the urethrais small and sensitive, No. 7 or No. 8 may best answer the purpose.W^ith experience a No. 10 will be satisfactory in the majority of cases.The urethral orifice is cleansed with boric acid, an assistant holdsthe labia and buttocks apart, while the operator grasps the specu-lum, as shown in Fig. 213, and gently forces it through the urethrainto the bladder. The obturator is held in place by the thumbuntil the cystoscope has entered the bladder, when it is withdrawn.

2CEXXH2 . A manual of gynæcology and pelvic surgery, for students and practitioners. required, as the simpler instruments anda very ordinary amount of dexterity and experience givesatisfactory information in the female. The interior of the female bladder may be inspected throughthe Kelly cystoscope by the aid of reflected light, or the short,electric-lighted, but direct-vision cystoscope may be used withoutthe intervention of mirrors and lenses. Before using either method the vulva should be cleansed, theurethra thoroughly cocainized, and preparation made to con-duct the entire examination in an asept

2CEWYHW . The Principles and practice of gynecology : for students and practitioners. s are : 1. The speculum. 5. The exploratory needle and aspirator, 2. The sound and probe, 6. The stethoscope, 3. The dilator, 7. The microscope, 4. The curette, 8. The urethroscope and cystoscope.The Speculum.—The choice of the speculum is simplified by the statement that of the innumerable varieties onlv two require seriousconsideration, and that these two act on the same principle—as peri-neal retractors. Thev are: DIA Gyosis. 65 Sims speciiliim. Siiiiuiis spcciilimi.Sims speculum is ;m instniriicnt of proat 8ini])

2CEWWJB . The Principles and practice of gynecology : for students and practitioners. Cvstoscopy by Kellys method; patient in dorsal position: c, No 10 cystoscope , actual size;^ /, cystoscope, without obturator; gr, obturator. the kidneys. The beginner will often have great difiaculty in findingthe ureter. Even the experienced surgeon often fails. The dif-ficulty, however, always decreases with intelligent practice. DIAGNOSIS. 79 Examination in the Knee-breast Position.—Tii many oases, ospeciallyof stout woiiifii, in wliicli ilic bladder docs not readily l)ull(jon witli air Figure 30.. Cystoscopy by

2CEWW62 . The Principles and practice of gynecology : for students and practitioners. , as if for introduction; Z, cotton wound onstick for removing fluid from bladder. The examination is conducted on the same principles as in thedorsal position. Examination in this position requires the end of thecystoscope to be cut off obliquely, instead of transversely. DIAGyOSIS. 81 The Electrical Cystoscope.—This iiistriinient was invented lv Loiter,of Xiriiiia, aiul later iiiijtiovecl l)y (aspcr. jMitli the Inciter and Cas-per instnuuents earried the electric light ray into the bladder hy meansof refracting pr

2CEWTPA . The Principles and practice of gynecology : for students and practitioners. ^ by Avater than by air. 4. The urethra is dilated less widely. 5. The examination requires less time and less skill, and requiresno assistant. Comparison of Cystoscopes.—It is evident that the Nitze cystoscopeand the modifications of it, such as Caspers, are superior to the Figure 33.. Catheterization of left ureter by Casper cystoscope. Upper right-hand figure shows terminalpart of (Jasper cystoscope, with lamp and catheter, sli^^htly reduced size. Lower left-handfigure shows Nitze cystoscope, about one-third natur

2CEWTMB . The Principles and practice of gynecology : for students and practitioners. j,ieal r^KilKK M.. Catheterization f.f both ureters bv ( asper eystoscope. Right ureter has been catheterizedand fvstoscoix- withdrawn, leaving catheter in ureter. Cystoscope again introduced, and ettureter being cutheterized: R-C, catheter in right ureter: I^C, catheter being passed into lettureter; A and B, forceps and snare for intravesical operations ; a, rheophores. changes may be recognized. The instrument often has revealedthe presence of stones, tumors, and ulcers which had escapeddetection by the sound. Nume

2CEWTAA . The Principles and practice of gynecology : for students and practitioners. changes may be recognized. The instrument often has revealedthe presence of stones, tumors, and ulcers which had escapeddetection by the sound. Numerous cases in which cystitis is of only 84 GENERAL PRINCIPLES. secondary importance to other associated lesions, such, for example,as tumors, tuberculous ulcers, hemorrhoids of the bladder, are nowdaily observed by the cystoscope. Cystoscopy is of great value inpreventing blind and meddlesome treatment for a class of cases whichpresent the subjective symptoms of cystitis,

2CEW2YX . The Principles and practice of gynecology : for students and practitioners. Stone in the bladder, a cause of foreign-body cystitis. a traumatism at the neck of the bladder or in the trigone. As seentluough the cystoscope, the fissure is covered usually by a brownishor yellowish exudate surrounded by an oederaatous area. Figure 148.. Hairpin in the bladder, a cause of foreign-body cystitis. 7. Foreign-body Cystitis.—Cystitis caused by foreign bodies (Figures147 and 148) varies with the character of the body and the conditionsof infection. A smooth body may be tolerated without sul)jective 326

2CET61R . The New England medical gazette : a monthly journal of Homoeopathic medicine, surgery, and the collateral sciences. ha. I was asked bymy senior, Dr. Bishop, to cystoscope her. The bladder was normaland the left ureter easily catheterized, but I was unable to locate orpenetrate the right ureter; Dr. Sprague Carleton had the same ex-perience a few days later. A second attempt by Dr. Carleton wassuccessful in locating the ureter, but the catheter was arrested aninch and a half from the mouth of the ureter. I made repeatedefforts to dilate the canal, without any results. We demonstratedthe point

2CET4B7 . The New England medical gazette : a monthly journal of Homoeopathic medicine, surgery, and the collateral sciences. Fig. 2. Tuberculosis of Bladder, secondary to lesion of kidney and ureter, unilateral.From a water color made by Dr. Philip Schmahl of New York from direct view throughthe cystoscope. The ulcers are seen clustered about the mouth of the right ureter; acatheter is shown in the ureter which has the induration and peculiar pathologicalchange designated as the golf-hole ureter, pathognomic of renal tuberculosis. Iatientcured of all vesical lesions by nephrectomy. 62 The Nezv Englan

2CET2Y7 . Annals of surgery. Case VIII.—Right ureteral orifice,mal, contracting. or- Case VIII.—Left ureteral orifice. Ap- parently rigid; otherwise normal. Kidneywas tuberculous. CYSTOSCOPIC EXAMINATION IN TUBERCULOSIS. 245 within the bounds of the normal. After the study of aseries of cases with an adequate cystoscope (I have usedexclusively the prismatic) it is not difficult to recognize andclassify the variations of a normal ureter. Cases I, II, III and IV show changes in the ureter whichare practically only seen in renal tuberculosis. Case VIshowed no ureter changes but a bladder tuberculosis, w

2CER0EE . Transactions of the Southern Surgical and Gynecological Association. of her age, Ifeared I would not be able to dilate the urethra sufficientlyto admit my cystoscope, so secured an instrument used byrhinologists, the salpingoscope, which I had seen recom-mended for use in the bladder of children, and found thatit worked excellently in giving one a view of the interiorof the bladder, and I commend it to those who may havesuch cases in children too small to be subjected to the intro-duction of the ordinary cystoscope. I found, however, thatI could use my catheterizing cystoscope with very litt

2CER05B . Journal - American Medical Association. pelvic lymphatic glandshave been found in only a small number of even themore advanced cases, and as they are occasionally pres-ent with ordinary prostatitis their presence or absenceis of little diagnostic or prognostic value, unless theyare a prominent feature. A remarkable characteristicof cancer of the prostate is that metastases directly tothe osseous system occur more often than to the glands.The cystoscope has been of the greatest assistance inthe diagnosis in early cases, as it has shown a distinctand radical difference in the intravesical pict

2CEM2NY . Surgical and gynæcological nursing. so used for the cystoscopicexamination of the bladder with the electric cystoscope. 7. Elevated Dorsosacral Position.—The difference betweenthe simple and elevated dorsosacral positions is diametrically POSTURES 105 opposite to that between the simple and elevated dorsal positions.Here it is the hips that are elevated by pads or the Trendelenburgattachment. The elevated position is sometimes preferred forthe sake of convenience and is also used by some physicians forbladder examination with the Kelly cystoscope. 8. Right (or Left) Lateral=Prone Position (F

2CEHPDF . Annals of surgery. n. In man the case is different. Brenner, Poirier, and Boiseau duRocher have not been able by their methods to catheterize the maleureter with any degree of certainty. We can see the mouths of the ureters so clearly with the cysto-scope that it seems as though it would be very easy to introduce aninstrument under the guidance of the cystoscope. In the woman,when a small sound is carried in alongside of the cystoscope, it is MALE GENITO-URINARY ORGANS. 407 very easy to introduce it with the aid of the eye into the ureteralopening. But farther than this opening it cannot be

2CEG9XH . A new manual of surgery, civil and military. ^ constructed and durable. Onlyone insertion of the instrument is necessary for viewing, catheterizing theureters, fulgurating or removing stones; a fact of prime importance, especiallyin the male. The following is a list of instruments which we use: 1 Braash cystoscope complete with double catheterizing tube. 3 extra tungsten lamps. 1 current rheostat and attaching cord. SURGERY OF THE GENITO-URINARY TRACT 541 2 No. 5 Forges bismuth impregnated ureteral catheters.1 fulgurator-generator (Wappler).1 fulgurating wire.1 operating forcep. 1 glass jar

2CEG92A . A new manual of surgery, civil and military. ance of pus therein. The use of the cystoscope and catheterization ofthe ureters, combined with radiography, is of great importance in the diag-nosis of renal tuberculosis. If the diagnosis is made before both kidneys are involved, the plan oftreatment is very clear, which is early removal of the affected kidney. The operation of nephrectomy, as described below, should be carried out inthese cases, but should embody the following points: removal of the ureter aslow down as possible and a thorough cauterization of the stump, and as com-plete a remo

2CDM81X . Surgery, its principles and practice . Fig. 217. -Position of Cystoscope when Viewin© Margin ofProstatic Orifice. 422 SURGERY OF THE PROSTATE. and a median lobe; h, the median and right lateral lobes confluent, thatis, forming a single large mass (two sulci being present, one betweenthe two lateral lobes and one between the left lateral and median lobe);. Fig. 218.—Views of the Normal Prostatic Orifice. i, the opposite, the median lobe being confluent with the left lateral;j, the median enlargement in the shape of a bar which is confluent wdthoutintervening sulci with an enlarged lateral lob

2CDM7CH . Surgery, its principles and practice . Fig. 222.—^Median and Bilateral Lobes. Fig. 223. -Median Confluent with bothLateral, Lobes. the other of the median lobe into one of these sulci, and very puzzlingpictures will be obtained unless care be taken. By the use of this cystoscopic chart, however, one is able to get a veryaccurate idea of the size and configuration of the intravesical prostaticenlargements, and information of very great value, especially whenoperation is to be performed, is obtained. The cystoscope is also ofgreat value in determining the presence or absence of calculi, divert

2CDE32A . A reference hand-book of gynecology for nurses . Fig. 57-—Instruments required for a cystoscopic exami-nation: 1, Sponge forceps; 2, small Sims speculum; 3, Coniccalibrator; 4, Hegar urethral dilator; 5, Kelly cystoscope;6, ureteral searcher; 7, alligator forceps; 8, bladder evacuator. Glassware (Fig. 56): Catheter. Catheter with six inches of rubber tubing attached.Glass funnel with four feet of rubber tubing and a glass irrigating point attached.. Fig 58.—Glass and enameled ware articles for a cystos-copic examination: 1, Evacuatcr; 2, funnel and tubing; 3,medicine-dropper; 4, bowl; 5, pus

2CDDYKJ . A reference hand-book of gynecology for nurses . glass;7, small cup. Two conic urine glasses. Medicine-dropper with slender tip and with rub-ber cap tied on. 126 GYNECOLOGY FOR NURSES Enameled ware: Bowl to hold under cystoscope.Pus pan to receive instruments.Two small medicine cups.Three small bowls for the dis-infecting outfit.Supplies: Tube of tiny cotton balls.Package of square gauze.Sterile cystoscope sheet.Package of sterile towels.Solutions: Boroglycerin. Protargol, i per cent.Cocain, 10 per cent.Silver nitrate, 3 per cent.Equipment.—Cystoscopic examinations arecarried out on a low tr

2CDA5M0 . Minor and operative surgery, including bandaging . ntraction of the affected or wasted muscles, and thusimprove their nutrition. Franklinization.—The earliest application of electricityin the treatment of disease was in the form of staticalelectricity, and although it fell into disuse, it has recently,with the perfection of modern machines, been widely re-vived. In applying statical electricity the patient maybe treated by insulation, or the so-called dry electric bath. THE CYSTOSCOPE. 171 The second method of using statical electricity is by sparksor shocks from a Leyden jar. which is charg

2CDA5C0 . Minor and operative surgery, including bandaging . ystoscope. Tap.k.1 instrument-. A cystoscope consists of a beaked sound inwhich there is a telescopic arrangement, by which the innersurface of the bladder is viewed through a -mall windowof rock crystal. The lamp is enclosed in the beak of theinstrument and throws its light through another window,also of crystal, upon any part of the bladder wall. Thebladder should contain six or eight ounces of clear urineor clear water if a proper view of the walls is to be ob-tained. If the fluid is turbid or contains blood, the viewis very much obscured

2CD8NK5 . Surgery, its principles and practice . ontact with it, as is well shown in Fig. 147. It is only bycontact that the searcher obtains its positive evidence. Not so with thecystoscope; this latter may indicate the presence of stone either by touchor by vision, near or at a distance, and its negative evidence is as valuableas the positive. A bladder whose entire cavity has undergone inspectionthrough a good cystoscope without disclosing a stone can be declared freefrom such a body. Method of Using the Stone=searcher.—This instrument isfurnished with an especially short beak, for the purpose of a

2CD8MXK . Surgery, its principles and practice . Fig. 149.—Cathelins Urinary Segregator (Hirst). In carrying out the procedure two conditions must be avoided, elsethe object is defeated: the bladder must be kept at rest, free from con- Ficf.l.. Fig. 150.—Schlagintweits Retrograde Cystoscope.Fig. 1, lens within the shaft, giving right-angle view. Fig. 2, lens emerging, giving partial retro-spective view. Fig. 3, full retrospective view. tractions or spasms; and artificial hemorrhage must be avoided. Asthe segregator must remain within the bladder during the time that urine 282 SURGERY OF THE BLADDER. d

2CD8ME3 . Surgery, its principles and practice . elf, from prostatic outgrowths, bladdercontractions or peristalsis, or inaccuracyof adjustment of the instrum-ent. Blad-ders are not inclined to be submissive toabnormal distention, such as this, for thirtyminutes at a time. In contrast to this,it may be mentioned that when ureteraldrainage is effected through catheteriza-tion, the cystoscope is taken out of thebladder immediately after the cathetersare inserted, permitting the drainage togo on with nothing but the small cathetersretained; and these are seldom, if ever, complained of, even by the mostse

2CD8M3C . Surgery, its principles and practice . Direct . , Cattie1eri2.ing Fig. 155.—Tilden Browns Composite Cystoscope. but not from both concavity and convexity. The cystoscopes of TildenBrown (Fig. 155) and my own (the Universal) work on both concavity. Fig. 156.—The Bransford Lewis Universal Cystoscope, Direct Catheterizing TelescopeIN Place, Illuminating Above and Below (Water Medium). and convexity, the lamps being so arranged in these that they shed light inboth directions, and lenses are provided to supply views in both directions.

2CD8KWK . Surgery, its principles and practice . Fig. 159.—Indirect Catheterizing Arrange-ment, Universal Cystoscope.*. Fig. 160.—Bransfohd Lewis Double Male Ureter Cystoscope (Air Distention). The bladder must be well cleansed, freeing it of mucus, pus, or bloodthat would cloud the distending fluid and obscure the vision. Thispreliminary washing is done through a soft-rubber catheter, followingwhich the anesthetic is applied and clear fluid is injected and allowed toremain in the bladder, to serve as the distending medium. With theTilden Brown or the Bransford Lewis cystoscopes, the washing may bedon

2CD8KKE . Surgery, its principles and practice . h theTilden Brown or the Bransford Lewis cystoscopes, the washing may bedone through the sheath of the instrument, which carries a large, fullstream back and forth; and no time need be lost in inserting the catheter-izing telescope through the sheath after the cleansing is effected. * Plans and specifications completed, but delayed in execution. 286 SURGERY OF THE BLADDER. A sufficient quantity of fluid must be introduced to afford workingspace for the cystoscope. Less than three ounces in the bladder is im-practicable; from five to ten ounces is servic

2CD8K37 . Surgery, its principles and practice . even where two or three grains ofcocain are used. Alypin and novocain areconsiderably less toxic than is cocain, and arealmost equally as effective. Loss of sensitiveness of the vesical neckmay be tested by further manipulation ofthe depositor; which, when attained, is fol-lowed by filling of the bladder with clear fluidand the introduction of the cystoscope. The light having previously been testedand adjusted, is now turned on and a pre-liminary survey of the field is taken. Sup-posing the cystoscope to be of the Nitzetype (the lens on the concavity),

2CD8J6B . Surgery, its principles and practice . , Universal Cystoscope. DIAGNOSIS OF VESICAL AFFECTIONS. 289 der or of the intestines behind it produce changes in their location andrelationship, even in the same individual. Inflammatory conditions of the bladder-membrane often increase thedifficulty of detecting the ureteral openings, by adding to the number ofdimples and depressions that resemble the openings, or by sinking thereal opening into the edematous membrane in such a way that it is noteasily recognized. But experience and practice will remove much ofthis difficulty. A ureteral opening havi

2CD8HP9 . Surgery, its principles and practice . ravesical and intra-ureteral manipulations, in-cluding catheterization. Through the authorsoperative cystoscope (Fig.168), and with the aid of theseveral appurtenances per-taining thereto, foreign bodiesand small calculi may begrasped and removed, ap-plications may be made tothe bladder wall with a swab,and galvanocauterization ef-fected. The field of intra-ureteral work within thesphere of this instrumentembraces the dilating or in-cision of the ureteral orifice,sounding of the ureter forstone, and removal of a stonefrom the lower end of theureter. **-

2CD8HK1 . Surgery, its principles and practice . Fig. 168.—The Bransford Lewis Operative Cystoscope and Appurtenances Pertaining Thereto. dilators, forceps, etc., a perforated window is used instead of the plain one,which permits the operator to manipulate while within the direct fieldof his vision, and also to maintain sufficient air in the bladder for dis-tention (this with continued attention from the assistant). Catheteriza-tion and sounding are effectedthrough the conducting tubethat passes through the per-forated window, in this instru-ment. Difficulties and impedi-m.ents to cystoscopy and cathe

2CD8EDY . Surgery, its principles and practice . Fig. 174.—Congenital Diverticulum in theBladder Wall (Nitze).The smooth round edges, us well as thebottom of the cavity, are plainly evident, asdistinguished from, the acquired form of diver-ticula; no other sacculations appear in thewall of the bladder. Fig. 175. - Dilated Ureter and UreteralOpening (Fenwick). cystoscope is the means, par excel-lence, for disclosing both sacculationand stone (Figs. 173, 175). It is common to observe sacculations of variable number and size inmaking cystoscopic investigation of prostatic cases. Although there is little

2B701DK Cystitis. Inflammation of the bladder. The structure of the kidneys and bladder. Excretory system. Infographics. Vector illustration.

2B60137 Cystitis. Inflammation of the bladder. The structure of the kidneys and bladder. Excretory system. Infographics. Vector illustration on isolated

2B600PJ Cystitis. Inflammation of the bladder. The structure of the kidneys and bladder. Excretory system. Infographics. Vector illustration on isolated

2AXGMKT Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . de ciments inaltérables à la stérilisation, mais leprincipe de linstrument ne varie pas el la manière de sen servir nen a pasété modifiée. Il serait donc tout à fait inutile de passer minutieusement enrevue les différents modèles et il nous suffira de décrire le type le plus habi-tuellement employé qui ne présente que des différences insignifiantes suivantla maison qui les construit. Un cystoscope se compose essentiellement de deux parties distinctes : lapartie éclairante engainante et la partie optique centrale-Pendant longtemp

2AXGMCD Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . ince (fig. ?>) sert à relier le cystoscopeà une source délectricité quelconque. Sa forme varie un peu suivant le construc-teur. Elle est essentiellement constituée dedeux plaques de métal B et C, recevant cha-cune un des fils du cordon. Ces deux plaquesmétalliques sont isolées lune de lautre parune plaque débonite (E) et se terminent pardes mors M prenant respectivement contact,lorsque la pince est adaptée au cystoscope,avec les deux rondelles métalliques de celui-ci (R. IV. fig. ,>) destinées à cet usage. Lune des plaques

2AXGJTH Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . Fig. 16. — Manière de localiser exactementune tumeur apparaissant au-dessous dela bulle dair. A. — On retirera le cystoscope jusquau moment oùlon verra apparaître le col. — C. Dans ce cas, la tu-meur doit être localisée sur la paroi antérieure entrela bulle dair et le col. Fig. 17. — Localisation dune tumeur situéeau voisinage de lorifice urétéral gauche I.a tumeur est située en dehors de lorifice pois-quelle se trouve du côté de la convexité de lorificeurétéral. Dautre lart, en retirant le cystoscope, latumeur apparaît située e

2AXGGNC Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . cope.fond sera garni avec de louate el elle sera remplie avec de lalcool, de leau () Pour la démonstration aux élèves, un fixateur pour le cystoscope est extrêmement utile parce quilpermet dimmobiliser le cystoscope dans la position la meilleure pour observer une région vésicale intéres-sante. Le plus commode de ces lixateurs est celui de Gentile ili^. il) qui se monte sur la laide de cysto-scopie et saisit le cystoscope au moyen dune pince à ressort se fixant sur une boule que lon peut adapterîle façon extemporanée à la pince d

2AXGGC2 Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . la glycérine stérilisée destinée à lubrifier le cystoscope. Elle présentesur lhuile lavantage de se dissoudre dans leau et de ne pas laisser sur le prismede petites gouttelettes qui pourraient troubler la transparence. 7° Accessoirement des solutions de cocaïne à i pour 100, dantipyrine à4 pour 100. Ces notions essentielles sur le matériel nécessaire à toute cystoscopie ayantété exposées, nous tenons £i dire un mot de la manière de le disposer, lorsquona à pratiquer une cystoscopie en dehors des salles spécialement préparées pou

2AXGG77 Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . i: u 2 m 1 . . ,,,,,,..,:,... -. *„* Fig. 26. — Nécessaire de cystoseopie. CE, cystoscope {dexploration. — ce, cystoscope à calhétérisme. — S, seringue. — D, dilatateur de Kelly pour lurètre de la IV ne. — IIP, Boite pour la pince. — BF, Boite pour des tampons. — BT, Boite perforée poui le trioxyméthylène. — H, Huile. — G, Glycérine. les pieds; une autre table sera placée à droite de la première pour recevoir lesobjets nécessaires à la cystoseopie. Le malade aura dû se procurer dautre part : 1° 20 centimètres cubes dune solution

2AXGF50 Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . e de cette cupule qui fait corps avec la masse du cystoscope, doùproduction dun court-circuit. Dans les deux cas, on aura avantage à procéder de lafaçon suivante pour vérifier le contact. On mettra lapince sur le cystoscope et lon établira le courant, puisayant attiré au maximum le fil de platine de la lampeon vissera celle-ci lentement sur le cystoscope. Si lab-sence déclairage était le fait dun défaut dans le contact,à un moment donné le fil touchant le fond de la cupule,la lampe séclairera certainement. Si, en continuant àvis

2AXGE5B Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . opérateurs préfèrent placer le malade avec le tronc horizontal et lescuisses fortement relevées, les genoux étant soulevés et écartés par des portejambes comme dans la position de la taille périnéale (fig. 52). Dans ces deux positions, on aura avantage à placer le malade en situationlégèrement inversée. Dans certains cas, celte position doit pouvoir être exa-gérée, lors de lexploration de certains trigones soulevés ou déformés quiobligent à incliner très fortement le pavillon du cystoscope en bas. Avec unetable fixe lopérateur,

2AXGDW1 Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . itr. 31. — Position du malade sur la table de cvstoscopie. mise en contact avec le cystoscope et le courant est établi. Lintensité decelui-ci est augmentée jusquà ce que le fil de la lampe porté à lincandescencecesse de devenir distinct. Une intensité plus grande risquerait de brûler lesfilaments. Pour les lampes à filament métallique, particulièrement délicates,il sera nécessaire daugmenter très prudemment et très progressivement lin-tensité du courant qui doit toujours être faible. 38 CYSTOSCOPIE A VISION INDIRECTE ET RENVERSÉ

2AXGDKK Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . plie de plus de200 centimètres cubes, on doit se livrer à des mouvements de bascule du cys-toscope particulièrement accentués, sans cela on resterait trop éloigné de lasurface vésicale qui serait vue alors un peu sombre et dont certains détailspourraient échapper. 5° Introduction du cystoscope. — A. Chez lhomme, lintroduction du cysto-scope comprend trois phases : la traversée de lurètre spongieux, la pénétrationdans la région membraneuse, la traversée de la région prostatique. MANUEL OPERATOIRE. 41 1° La verge étant tenue verti

2AXGDDD Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . iate,quelques petits mouvements de rotation autour de son axe (fig. 35). 5° Une fois que le sphincter membraneux est franchi, il faut continuel- àabaisser le pavillon du cysloscope en même temps quon le pousse très douce-ment, le boulon qui sert dindex se trouvant toujours en haut (fig. 36). 42 GYSTOSGOPIE A VISION INDIRECTE ET RENVERSÉE. A un moment donné, le cystoscope pénètre librement : il est arrivé dans lavessie. La facilité avec laquelle on peut tourner linstrument autour de son axeconfirme la réalité de cette pénétration

2AXGD7W Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . dune sonde, il nempêchera pas le passage du cysto-scope, pas plus quil nempêche la pénétration du Béniqué. c) Dans la région prostatique, la pénétration peut être gênée ou arrêtée parlexistence dune hypertrophie. Si lon ressentait un obstacle à ce niveau, oncommencerait par abaisser fortement le pavillon du cystoscope au point demettre linstrument presque verticalement dirigé de bas en haut; il faut serappeler que le danger est à la paroi postéro-inféricure et quil ne sauraitrésulter dinconvénient de suivre intimement la paroi a

2AXGD2D Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . Fig. 35. — Pénétration du cystoscope dans lurètre membraneux grâce à un mouvement dabaissement de son pavillon. le cystoscope, auquel cas il faudra remettre lexamen à une date ultérieureaprès que lon aura régularisé le canal par une sonde à demeure. Le seul accident qui puisse se produire au cours de lintroduction du. Fig. 30. — Traversée de lurètre prostatique grâce à la continuation du mouvementdabaissement combiné à un très léger mouvement de propulsion. cystoscope est la fausse route qui se fera toujours au niveau de la régi

2AXGCXE TraitÃ¢e pratique de cystoscopie et de cathÃ¢etÃ¢erisme urÃ¢etÃ¢eral . Fig. 5x -39. â SchÃ©mas montrant comment par suite de la bascule du cystoscop i peut apercevoir un orifice urÃ©tÃ©ral impossible Ã voir lorsque le cystoscope se trouve enposition ordinaire. montre, et lon enfoncera le cystoscope comme prÃ©cÃ©demment pour le ramenerensuite au col. On continuera ainsi lexamen, Ã chaque fois le cystoscope Ã©tant tournÃ© dun MANUEL OPÃRATOIRE. 47 sixiÃ¨me de circonfÃ©rence et le bouton prenant successivement les positionsde 4 heures, 6 heures, 8 heures, 10 heures, du cadran dune montre (fig. 41

2AXGC73 Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . Fig. 41. — Schéma montrant les positionssuccessives que doit occuper le bec ducystoscope pour que la surface entièrede la vessie ait été explorée. Fig. 42. — Positions à donner au cysto-scope pour explorer la zone postéro-inferieure (trait plus épais) qui échappedans lexploration ordinaire. trouve dirigé à gauche. Pendant toute cette manœuvre, le cystoscope seraenfoncé de telle sorte que le bec touche la paroi sans trop appuyer sur elle.Grâce à cet artifice on aura vu la région immédiatement opposée au col, régionque lon néglige

2AXF3G5 Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . Fig. 49. — Schéma montrant comment aucas de très volumineux calcul la portionde ce calcul éclairé par la lampe est àpeine vue par le prisme. Fis;. 50. —Volumineux calcul dont le cysto-scope pourra faire le tour sans quil soitpossible de le voir, le prisme étant tou-jours trop près de lui. trait ordinairement que pour une position déterminée du cystoscope, parexemple en haut au cas de néoplasme implanté sur la paroi supérieure, et ilétait exceptionnel que par des mouvements de rotation, il ny eût pas toute unezone de la vessie où

2AXEX4H Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . Nousavons déjà insisté sur laspect clair quil revêt au niveau de la zone lumineusequi limite la saillie prostatique. Mais, de plus, on constate quelle présenteordinairement une belle coloration rouge, dun rouge chaud et velouté, et quirappelle tout à fait une belle pêche mûre. Elle est très fidèlement représentéesur les planches XXXI, fig. 1 et 5, et XXXII, fig. 2. V1 Dans dautres cas, lhypertrophie de la prostate se manifestera simple-ment au cystoscope par lobscurité du champ dans certaines positions dr lins-trument. Cela se p

2AXETNA Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . Fig. 4 MASSON & CÉditeurs Fig. 0. HYPERTROPHIE DE I..V PROSTATE. 153 cystoscope, ou bien on enfonçant linstrument, on peut retrouver la clarté vési-cale; il est possible dapercevoir le col soulevé par une saillie. Mais souventaussi, malgré toutes les inclinaisons que lon donne au evsloscope, malgréquon lenfonce au maximum, il est impossible de voir quoi que ce soit. Parcontre, aussitôt quon tourne en haut le prisme, la vessie apparaît 1res nette.11 sagit alors dune saillie du col en arrière tellement considérable que la lon-gueu

2AXERKN Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . cidely convex. but with stillperceevable meatus. Same aspect with visible meatus. Blood suffusion on a prostatic prominence. Prostatic prominence seen in a retrograd cystoscope. STAMPA XXXII. FlG. 1 Fig. 2 Fig. 3 Fig. 4. Fig. 5 Primo grado ilipertrofia prostatica, che lascia vedere loriflcio ureterale. Grado più accentuato dell ipertrofia, gia francamente convessa; ma tuttavia sipué ancora scorgere il meato. Il medesimo aspetto, con meato visibile. Sufïusione sanguigna sopra una sporgenza prostatica. Sporgenza prostatica veduta

2AXEM7C Traitâe pratique de cystoscopie et de cathâetâerisme urâetâeral . Fig.3 Fig. 4. Fig. S MASSON & CÉditeurs HYPERTROPHIE DE LA PROSTATE. 155 urétéraux (comme cela peut arriver dans le prolapsus de la paroi vaginaleantérieure chez la femme). B. — Lorsque lhypertrophie de la prostate atteint un certain volume, il seproduira une autre modification dans le rapport du col et des orifices urété-raux. Ceux-ci se trouveront complètement cae/tét par In saillie cervicale : ilsera impossible de les découvrir, quelque position que Ton donne au cystoscope. Images obtenues avec le cystoscope rétrograde Le col