An excerpt from A Critical Enquiry into the Present State of Surgery by Samuel Sharp, 1754

THE Patient being prepared as in the other Methods ; he [the surgeon] orders him for some Hours before the Operation to retain his Urine, notwithstanding any Urgings to void it. By this means he proposes to distend the Bladder more effectually than can possibly be done by an Injection ; which being flung in faster, than the Bladder is accustomed to receive the Urine from the Kidneys, makes a small Distention very painful. When the Patient can no longer resist the Irritation to Urine, a Yoke is put on the Penis, to prevent the issue of the Water from the Bladder. Being then placed in the usual Posture for Cutting, an Assistant with a convenient Bolster, presses the Abdomen a little below the Navel in such a manner, that by pushing the Bladder forwards, he may make that part of it protuberate which lies between the Neck and the Ureter. The Operator at the same time, introduces the Forefinger of his Left-hand up the Rectum, and drawing it down towards the right Buttock, pushes in a Trocar on the left Side of the Perineum, near the great Tuberosity of the Ischium, and about an Inch above the Anus: Then the Trocar is to be carried on parallel to the Rectum, exactly between the Erector Penis and Accelerator Urinæ Muscles, so as to enter into the Bladder on one side of its Neck: As soon as the Bladder is wounded, the Operator withdraws his Fore-finger from the Anus.

THE Trocar is longer than a common Trocar, and is made with a kind of Handle, that determines it into an upper and a lower Part. On the upper Part of the Canula, is a Groove continued almost to its Extremity : By the means of this Groove some Urine will issue out, when the Trocar penetrates into the Bladder ; at least, if he draws out the Perforator a little way, which will serve as an Indication to the Operator that he must not push it any farther: But the principal Use of the Groove is to guide the Incision, after the Perforator is withdrawn ; this Incision must be carried between the above-mentioned Muscles, through the Skin, Membrana Adiposa. Transversalis Penis, Levator Ani, and a little Portion of the Ligament that runs into the Neck of the Bladder, from the Symphysis of the Os Pubis; and lastly, through the Body of the Bladder at near half an Inch from its Neck, and at the same Distance above the Insertion of the Ureter. The length of the Incision through the Skin, is to be above an Inch and a quarter, running obliquely upwards from one sixth of an Inch on the Inside of the great Tuberosity of the Ischium, to the same Distance on the Inside of the Seam in Perinæo. The length of the Incision in the Bladder itself is to be something more than an Inch.

For making the Incision more conveniently, M. Foubert has devised a Knife, the Blade of which is fixed into the Handle in such a direction; as to resemble a Clasp-knife a little shut; by this Artifice, he cuts with much more facility, than if the Handle lay in a right Line with the Blade : But to conceive rightly of this Operation, one should see either the Instruments themselves, or the Figures of them, which he has annexed to the Description of his Method.

When the Incision of the Bladder is made, he introduces the Gorget upon the Groove of the Canula, after which, the Operation is finished as in the other Methods ; only that his Gorget is differently contrived from the Gorgets which are moft in use.

These are nearly the Particulars of M. Foubert‘s Method of Cutting ; but though he has practised it several Years with great Dexterity, if I may judge by the Operation I myself have seen him perform, and, with good Success, according to his own Declaration ; nevertheless he has not yet had the Happiness to persuade any of his Countrymen to adopt it; and I presume for the following Reasons.

Because there are many Bladders, which, from the continual Irritation of the Stone, have been Ill accustomed to discharge the Urine as fast as it flows from the Kidneys, that they become very small ; and at the fame time are incapable of a sufficient Distension, either by Injection, or a gradual Influx of Urine from the Kidneys: For want therefore of a proper Guidance, it may sometimes happen, that the Trocar will pass between the Bladder and Rectum; at other times, as the Trocar is very long, even through the Bladder into the Pelvis.