LITHOLAPAXY IN MALE CHILDREN.
May, 1887.]
The
boy
hospital
(Srijjinal (ttommuraMtimt!!, LITHOLAPA^Y
CASES OF
IN MALE
CHILDREN. By Surgeon-Major D. O'CONNELL
RAYE, M,D., Professor of Anatomy, Calcutta Medical College, and Second Surgeon, College Hospital, In
conversation which I had with my friend* of Indore, some three years ago during his short visit to Calcutta, 1 learned from him the admirable results which he was obtaining by practising litholapaxy in children, and I determined to follow his example Stone being a rare disto the best of my ability. ease in Lower Bengal, I am only able to bring forward four cases in which I attempted litholapaxy in children. Small as is the number, they may be found to present some points of interest. I feel, moreover, that when a new operative procedure has been brought before the profession, it is right that each of us should give our experience of it, even though limited. a
Surgeon-Major Keegau
My
first
case
was a
ment which I used
case, it is
lithotrity
boy aged
was
five. The instru-
that marked C in Weiss's
fully fenestrated,
measures
fraction more than a No. 9 so English catheter, far as I could gauge it. For an evacuator I got a workman to fashion the beak of a No. 9 plated catheter after the model of a Bigelow's evacuator, and had a metal collar put on to the end of the catheter so as to fit it to Weiss's evacuating bottle. The joint did not fit accurately, but this was remedied by slipping a bit of drainage tube over the joint, when the at
the shoulder
parts
were
a
placed together.
After a preliminary incision of the meatus, the lithotrite passed without any trouble, aud a small stone was easily crushed. The evacuator was then used in the usual way. A second introduction of the lithotrite completed t ie and a second evacuating completed crushing, t ?e operation, which occupied about fifteen minutes.
I regret that through a mistake the fragments were thrown away by one of the attendants before ley were weighed ; the debris, however, would have about filled a small and
drachm036 In this
difficulty
WeigUed' roughly
eo-cr spoon,
speaking,
half
a
case a No. 9 passed without the least into the urethra of a boy of five years.
was
five
perfectly
days
later.
129
well next
day,
and left
My next case was in all respects similar. The boy's age was five and a half. The same instrument was used, and passed without any incision of the meatus. There was no difficulty whatever experienced. The lithotrite was introduced three times, aud the evacuator a similar number of times, though the duration of the operation was about half an hour. This is rather longer than a small stone (20 grains) ought to have occupied, but so far as I recollect, some time was wasted in an over zealous search for any possibly remaining fragments. This boy recovered without a bad symptom, and was discharged on the fourth day. I next operated on a boy of 23 months. I used No. 9 lithotrite and evacuator. It passed with perfect ease and without any incision of the meatus, which part was of comparatively monster calibre. The stone was a small one, 15 grains, and one crushing sufficed for its removal. This infant also recovered without trouble of any sort. Lastly, I attempted to perform litholapaxy on a boy aged 8?. The smallest instrument in my possession was a No. 8 Weiss's. It would not pass the meatus, which I accordingly incised. The instrument then passed rather tio-htly gripped as far as the bulb, but beyond tins I could not pass it without using more force than I deemed advisable. Having no smaller lithotrite, I then introduced a small grooved staff and performed lateral lithotomy, removing an eggshaped calculus of 63 grains. The boy recovered, but was a month in hospital.
a
These
two last cases are of interest, corrobowhat has been pointed out by Dr. rating Keegan, that age has nothing to say to the size of the urethra in young children. A boy of two years admitted a No. 9 with ease; a boy nearly nine years would not admit a No. 8. I regret that I had no smaller instrument, as a No. 7 staff passed quietly, aud with a No. 7 lithotrite I might have crushed the 63-grain calculus, aud reduced the boy's resideuce in hospital from a month to a few days.
My limited experience induces me to form a very high estimate of the utility of Dr. Keegan's
The absence of in surgery. recovery and the extreme rapidity of the Gure are very remarkable when this operation is applied to children. Litholapaxy in young subjects is, I think, more difficult than in adults, and it would probably be unwise for an absolutely inexperienced hand to make his first essay on an infant. Gentleness and care are needed, but the same may be said for most new
advance
trouble
during
surgical procedures.
17
May, 1887.]
The
boy
hospital
(Srijjinal (ttommuraMtimt!!, LITHOLAPA^Y
CASES OF
IN MALE
CHILDREN. By Surgeon-Major D. O'CONNELL
RAYE, M,D., Professor of Anatomy, Calcutta Medical College, and Second Surgeon, College Hospital, In
conversation which I had with my friend* of Indore, some three years ago during his short visit to Calcutta, 1 learned from him the admirable results which he was obtaining by practising litholapaxy in children, and I determined to follow his example Stone being a rare disto the best of my ability. ease in Lower Bengal, I am only able to bring forward four cases in which I attempted litholapaxy in children. Small as is the number, they may be found to present some points of interest. I feel, moreover, that when a new operative procedure has been brought before the profession, it is right that each of us should give our experience of it, even though limited. a
Surgeon-Major Keegau
My
first
case
was a
ment which I used
case, it is
lithotrity
boy aged
was
five. The instru-
that marked C in Weiss's
fully fenestrated,
measures
fraction more than a No. 9 so English catheter, far as I could gauge it. For an evacuator I got a workman to fashion the beak of a No. 9 plated catheter after the model of a Bigelow's evacuator, and had a metal collar put on to the end of the catheter so as to fit it to Weiss's evacuating bottle. The joint did not fit accurately, but this was remedied by slipping a bit of drainage tube over the joint, when the at
the shoulder
parts
were
a
placed together.
After a preliminary incision of the meatus, the lithotrite passed without any trouble, aud a small stone was easily crushed. The evacuator was then used in the usual way. A second introduction of the lithotrite completed t ie and a second evacuating completed crushing, t ?e operation, which occupied about fifteen minutes.
I regret that through a mistake the fragments were thrown away by one of the attendants before ley were weighed ; the debris, however, would have about filled a small and
drachm036 In this
difficulty
WeigUed' roughly
eo-cr spoon,
speaking,
half
a
case a No. 9 passed without the least into the urethra of a boy of five years.
was
five
perfectly
days
later.
129
well next
day,
and left
My next case was in all respects similar. The boy's age was five and a half. The same instrument was used, and passed without any incision of the meatus. There was no difficulty whatever experienced. The lithotrite was introduced three times, aud the evacuator a similar number of times, though the duration of the operation was about half an hour. This is rather longer than a small stone (20 grains) ought to have occupied, but so far as I recollect, some time was wasted in an over zealous search for any possibly remaining fragments. This boy recovered without a bad symptom, and was discharged on the fourth day. I next operated on a boy of 23 months. I used No. 9 lithotrite and evacuator. It passed with perfect ease and without any incision of the meatus, which part was of comparatively monster calibre. The stone was a small one, 15 grains, and one crushing sufficed for its removal. This infant also recovered without trouble of any sort. Lastly, I attempted to perform litholapaxy on a boy aged 8?. The smallest instrument in my possession was a No. 8 Weiss's. It would not pass the meatus, which I accordingly incised. The instrument then passed rather tio-htly gripped as far as the bulb, but beyond tins I could not pass it without using more force than I deemed advisable. Having no smaller lithotrite, I then introduced a small grooved staff and performed lateral lithotomy, removing an eggshaped calculus of 63 grains. The boy recovered, but was a month in hospital.
a
These
two last cases are of interest, corrobowhat has been pointed out by Dr. rating Keegan, that age has nothing to say to the size of the urethra in young children. A boy of two years admitted a No. 9 with ease; a boy nearly nine years would not admit a No. 8. I regret that I had no smaller instrument, as a No. 7 staff passed quietly, aud with a No. 7 lithotrite I might have crushed the 63-grain calculus, aud reduced the boy's resideuce in hospital from a month to a few days.
My limited experience induces me to form a very high estimate of the utility of Dr. Keegan's
The absence of in surgery. recovery and the extreme rapidity of the Gure are very remarkable when this operation is applied to children. Litholapaxy in young subjects is, I think, more difficult than in adults, and it would probably be unwise for an absolutely inexperienced hand to make his first essay on an infant. Gentleness and care are needed, but the same may be said for most new
advance
trouble
during
surgical procedures.
17
