2. Partial Cystectomy,

If a sessile or thick-pedicled tumour be found on the
lateral or anterior walls — a rare contingency — the wall is
bared by stripping it with the fingers and the tumour is freely
cut out, the cut passing straight through the bladder-wall at
least one inch from the edge of the tumour. The bladder-
wall is repaired with catgut sutures after the haemorrhage
has been controlled and supra-pubic drainage is established.
The immediate results of this operation are very encouraging,
but opportunities for performing it are rare, it remains to
be seen whether recurrence is the rule or the exception.
The operation may be performed extra- or intra-peritoneally.
So long as the bladder is not infected there is no risk in
opening the peritoneum and exposing the bladder-wall freely.
The Trendelenberg position is adopted and the intestines are



314 DTSEARFS OF THE BLADDER.
packed off from the field of operation with gauze pads or fiat
sponges.
If the growth surrounds the ureter, a sound may be passed
up the ureter, the bladder-wall cleared all around, the growth
and lower end of the ureter cut out, and tlie cut end of the
ureter be implanted into the bladder afresh. The end of the
ureter must be split a little and the two flaps united to the
raucous membrane of the bladder with fine catgut.
3. Total Cystectomy.
