An operation should not be proceeded with nor an attempt made to extract the stone (Salya) in a case where, the stone on being handled, the patient would be found to drop down motionless (i.e., faint) with his head bent down, and eyes fixed in a vacant stare like that of a dead man, as an extraction in such a case is sure to be followed by death. The operation should only be continued in the absence of such an occurrence.
An incision should then be made on the left side of the raphe of the perineum at the distance of a barleycorn and of a sufficient width to allow the free egress of the stone. Several authorities recommend the opening to be on the right side of the raphe of the perineum for the convenience of the operation. Special care should be taken in extracting the stone from its cavity so that it may not break into pieces nor leave any broken particles behind (i.e., inside the bladder), however small, as they would, in such a case, be sure to grow larger again. Hence the entire stone should be extracted with the help of an Agravaktra Yantra (a kind of forceps the points of which are not too sharp). 13.
In a woman, the uterus (Garbhás'aya) is adjacent to the urinary bladder, hence the stone should be removed by making an oblique and upward incision, otherwise a urine-exuding ulcer might result from the deep incision in that locality. Any hurt to the urethra during the operation would be attended with the same result even in a male patient. An incision made only on one side of the organ in a disease other than that of stone, baffles all attempts at healing; while an ulcer incidental to an incision made on both its sides, should be deemed incurable An ulcer incidental to an incision made on either side of the bladder in extracting a stone might be healed up, inasmuch as medicinal potions and fomentations, etc., employed for the healing of a surgical wound, lead to the healing of the wound in the bladder; secondly because the surgical opening is only made large enough for the extraction of the stone as recommended in the authoritative books; and thirdly because an increase in the quantity of urine contributes to an increase in the size of the stone and hence a slight secretion of that fluid or employment of diuretic Peyás, etc., are not attended with any injurious effects.
Post-Surgical Measures:. - After the extraction of a stone, the patient should be made to sit in a Droni (cauldron) full of warm water and be fomented thereby. In doing so the possibility of an accumulation of blood in the bladder will be prevented; however if blood be accumulated therein, a decoction of the Kshira-trees should be injected into the bladder with the help of a Pushpa-netra (urethral Syringe). 14-15.
Stones and the accumulated blood in the bladder would be speedily expelled by means of injecting a decoction of the Kshira-trees into it with the help of a Pushpa-netra (urethral Syringe). 16.
For the clearance of the urinary passage, a treacle solution should be given to the patient; and after taking him out of the Droni, the incidental ulcer should be lubricated with honey and clarified butter. A Yavágu, boiled with the drugs * possessed of the virtue of cleansing or purifying the urine, and mixed with clarified butter, should be given to the patient in a warm state every morning and evening for three consecutive days.
After that period a diet (meal) of rice well boiled and mixed with milk and a large quantity of treacle, should be given (to the patient) in small quantities for ten days for the purification of the blood and the secretion of urine as well as for the purpose of establishing secretion in the ulcer. The patient should be made to partake of a diet (of rice) with the soup of the flesh of Jángala animals and the expressed juice of acid fruits after the lapse of these ten days. 17.
* The urine-purifying drugs are the Trina-Panchamulas, Gokshura, Kásamarda, Páshánabheda, etc.
After that period, the body of the patient should be carefully fomented for ten successive days by applying any warm oleaginous substance or with any warm medicinal fluid (Drava-Sveda). As an alternative, the ulcer should be washed with the decoction of (the bark of) the Kshira-Vrikshas. A paste of Rodhra, Madhuka, Manjishthá and Prapaundarika (pounded together), should be applied then to the ulcer. A medicated oil or Ghrita cooked with turmeric and the preceding drugs should be applied to the ulcer. The accumulated blood in the affected part should be removed with the help of a Uttara-vasti (urethral Syringe). The ulcer should be cauterized with fire in the manner described before in the event of the urine not flowing through its natural passage after the lapse of seven days. After the urine takes its natural course, Uttara-vasti, Asthápana and Anuvásana measures should be employed with the decoction of the drugs belonging to the Madhura- Varga.
A seminial stone or gravel (S'arkará) spontaneously brought down into the urinary passage should be removed through the same passage. The urethra should be cut open and the stone should be extracted with a hook (Vadis'a) or any other instrument in the case of its not being expelled out by the passage. The patient should refrain from sexual intercourse, riding on horse back or on the back of an elephant, swimming, climbing on trees and up mountains and partaking of indigestible substances for a year even after the healing of the ulcer. 18.