Clinical Remarks on the Present Position and Scope of Litholapaxy
Authors: P. J. Freyer
Journal: BMJ (1891)

My paper entitled Recent Experiences in Surgery of Stone in the Bladder: 100 Litlholapaxies aiid 32 Lithotomies," 1 brouhlit dowil thew record of iny operatiolns for stone in the bladder-553 in number by all methods-to the middle of April, 1889.1)uring thle period that has elapsed since that time (lown to t1e end of February, 1891, ouit of 168 cases of stone ill the bladder whiich have come under my treatment, in patients of all ages from 2 years to 90, no fewer than 165 have beeni dealt witlh by litlholapaxy.kSexv and Aqe: Duration qo Treatmnent.-There were anloiigst these 165 litiiolapaxy cases 99 adults-namely, 96 males and 3 females-and 66 male children, or lads up to the age of 15 years.The average age of the adult males was 51j years, varying from 18 to 90; that of the male children 71 years, varying, from 2 to 15: and that of the three females 523years.The average number of days spent-iix1hospital or under treat- menit (in case of patienits in private practice) was, in the case of adult niales, 6, varyiiig from 2 to 28 days; in the case of male chiidreii, 5. -nearly, varying from 2 to 21 days; and in the case of females, 4 days.It should be mentioned, however, that in most instan-ces the patients were kept in hospital one, two, or tlhree days more tlan was absolutely niecessary, merely as a precautionary menasure anid for purposes of observation.In nio onie case was the patienit allowed to leave hospital till lie lhad completely recovered.fWeight of calculi.-Tlheaverage weight of the dgbris of calculus removed was in adult males 242 grains, varying from :3 grains to 3 ounces anid one drachm; in elildren 108 grains, varying from 2' grains to 3 ounces aild 241 draclims and in wvomene 435 grains.The weiglhts here giveen are those of the dWbris wlhen tli oroughllv dry.]Reeurrent Stone.-Tlhese165 litholapaxies occurred in 164 different individuals, operatioins Nos. 388and 449 having been performed on the same person.On MIay 7, 1890, I removed from him a small phospliatic calculus, weighing 4 grains; lie remained perfectly well for three months, when symptoms of stone again set in, and on December 8th, 1890, I removed a second ston-e of the same composition, weighing 95 grains.Amongst these 165 cases of lithlolapaxy there were, in addition to the ease above, described, six other instances of recurrent stone-two after lithotomy and four after litholapaxy.Case :314 had un-dergone lateral lithotomy in hlis childhood, and Case 361 lateral litliotomy twice, four and ten years previously respectively.Cases 336, 404, and 426 h-iad been operated on by me two and a-h alf, seveI, and two and a-half years previously; and in Case 412 litholapaxy had been performed by another surgeon one year and a-lhalf before.All these patients had remained well an-d free from urinary symptoms for long perio(ls after the first operatioii, so tllat the second calculus in each instance hiad iio direct connection with the first.,Secon(l SittingXs.-IInmy previous writings I have laid great stress on the necessitv of removing the whole of the stone at one sitting; 161 out of the 165 operationis now under con- sicderationi were completed at a single sitting.It will, how- ever, be found occasionallythat a last fragment will sometimes evade detectioi.This is, undoubtedly, a weak point in tlle oleration: but, it is a weak point whichlsinks into insignificancee whlen compared with the advantages with which the operation is attended.Of the four instances in which a second sitting was necessary, in threee a fragment was undesignedly left behind.In all three cases the fragment revealed itself next