Astanga Hrudaya
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कृत्वान्तरे तथा वस्तिं निर्वलीकमनायतम् । उत्पीडयेदङ्गुलीभ्यां यावद्ग्रन्थिरिवोन्नतम् ॥ ५१ ॥
keeping the bladder smooth, free from folds, and tightly stretched. It should then be pressed upward with the fingers from within the rectum until the foreign body bulges out prominently like a firm tumor.
english translation
शल्यं स्यात्सेवनीं मुक्त्वा यवमात्रेण पाटयेत् । अश्ममानेन न यथा भिद्यते सा तथाहरेत् ॥ ५२ ॥
Avoiding the perineal raphe (sevanī), an incision should be made over the bulge, either of the size of a barley grain or matching the dimensions of the stone. The stone should then be carefully extracted in such a manner that it does not break or fragment,
english translation
समग्रं सर्पवक्त्रेण स्त्रीणां वस्तिस्तु पार्श्वगः । गर्भाशयाश्रयस्तासां शस्त्रमुत्सङ्गवत् ततः ॥ ५३ ॥
pulling it out completely using a sarpamukha (forceps resembling a snake's mouth). In women, since the bladder is situated close to the sides and is in proximity to the uterus, the surgical instrument should be introduced obliquely or with its face directed downwards,
english translation
न्यसेदतोऽन्यथा ह्यासां मूत्रस्रावी व्रणो भवेत् । मूत्रप्रसेकक्षणनान् नरस्याप्यपि चैकधा ॥ ५४ ॥
otherwise, there is a risk of creating a permanent urinary fistula (a wound through which urine constantly leaks) due to accidental injury. In men also, a similar risk of injury to the urethra exists.
english translation
वस्तिभेदोऽश्मरीहेतुः सिद्धिं याति न तु द्विधा । विशल्यमुष्णपानीयद्रोण्यां तमवगाहयेत् ॥ ५५ ॥
An incision made into the bladder once, for the purpose of removing the stone, can heal successfully; however, an incision done a second time (or in two separate places) does not lead to a successful recovery. Once the foreign body (stone) has been removed, the patient should be placed in a tub filled with warm water (avagāha sveda),
english translation