TUMORS OF THE BLADDER.
DIAGNOSED BY MEANS OF THE ELECTRO-ENDOSCOPIC CYSTOSCOPE.
By Dr. Max Nitze.
In the following lines I wish to direct the attention of my English confreres to the value of the electro-endoscopic mode of examination of the male urinary bladder, invented by me. I believe I could not have chosen a more suitable theme for that purpose than a short report of the bladder tumors diagnosed by me cystoscopically; for the diagnosis of these new formations offers the greatest difficulty, and in most cases it has been impossible till now to prove their existence with accuracy without digital exploration of the bladder. By the new method of cystoscopical examination the conditions have entirely changed. One look into the bladder, illuminated as if by daylight, is generally sufficient to afford means for forming an opinion of all the questions coming into consideration—viz., size, form, and site of the tumor. The accompanying diagrams (Figs. 1, 2, 3, 4) may give an idea of the appearances which the different forms of bladder tumors present endoscopically. I regret that they cannot show the brightness of the light by which one sees the tumors during examination. The celebrated Vienna specialist, V. Dittel, is right in saying that "they offer sometimes truly charming pictures;" especially certain kinds of villous tumors, whose long slender villi floating in the liquid often present a splendid appearance. The following are the cases cystoscopically diagnosed by me.
Fig. 1.
Case 1.—A man, aged fifty-five, under the care of Dr. Ch. Mayer, suffered from attacks of hæmaturia for thirty years. During the last six years he has had dysuria and inability to empty the bladder completely. The patient had been examined by the sound repeatedly by eminent surgeons and specialists, but none could give a certain diagnosis. On Nov. 11, 1886, I undertook the cystoscopic examination. I found on the anterior wall of the bladder a puffy swelling covered with white masses of mucus. (See Fig. 1.) The trigone was covered by a mass consisting of pointed papillæ. On account of the weakness of the patient extirpation was impossible. The patient became weaker
and weaker, and died in June, 1887. The post mortem examination showed the internal orifice of the urethra surrounded by a swelling representing a continuous tumor as large as a small apple. It was found that the instrument had penetrated through the middle of this swelling, which bled easily on pressure. In spite of this, the clearness of the picture was not interfered with in the least.
Fig. 2.