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THE SURGICAL TREATMENT OF DIVERTICULA OF THE BLADDER
Author(s) -
ILLYÉS GÉZA
Publication year - 1940
Publication title -
british journal of urology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 0007-1331
DOI - 10.1111/j.1464-410x.1940.tb10410.x
Subject(s) - connective tissue , infiltration (hvac) , muscular layer , medicine , diverticulum (mollusc) , dense connective tissue , anatomy , pathology , materials science , composite material
Summary Number of diverticulum cases 168–of these 166 men, 2 women. Of the 168 cases of diverticulum 59 (36.0 per cent.) were surgical and men in every case. Tabulation of the diverticulum cases according to age: Histological examination was made of most removed diverticula. In the wall were usually found more or less well‐developed smooth muscle fibres that were thin in parts, and fat mixed with loose connective tissue completed the picture. In some cases there was inflammation with the thickening of the connective tissue in the wall, infiltration of small cells, and formation of young capillaries with gaping lumens. The elastic fibres were usually diminished, only complete in parts, while in many places we found thin and torn fibres. In some instances elastic fibres were absent. The mucous membrane was sometimes necrotic, epidermal layer not to be found, and small cell infiltration in the connective tissue. Rarely there was infiltration in the deeper layers and adhesions with the surrounding tissue (peridiverticulitis). I am convinced that the diverticulum must be treated surgically, because this is the only way that certain and lasting healing can be obtained. The operative interference is laborious and difficult and is a considerable ordeal for the patient, therefore it is important to make an exhaustive preoperative investigation before taking the patient into the operating room. The operation itself is done under sacral anæesthesia and local infiltration; usually general anæsthesia is not necessary; if this is used, however, then only the minimum of narcosis should be given. All tearing, jerking, undue torsion, and rough retraction are forbidden, and by this a great deal of pain is omitted. I owe much of my success in serious and complicated cases to the employment of perineal drainage; as a result, I have not seen a single gross infection develop or urinary extravasation in the true pelvis. Therefore I hold this simple drainage method to be excellent in all such cases.