File:An American text-book of genito-urinary diseases, syphilis and diseases of the skin (1898) (14782624525).jpg

Identifier: americantextbook00bang (find matches)
Title: An American text-book of genito-urinary diseases, syphilis and diseases of the skin
Year: 1898 (1890s)
Authors: Bangs, Lemuel Bolton, 1842-1914 Hardaway, W. A. (William Augustus), 1850-1923
Subjects: Urogenital System Urination Disorders Syphilis Skin Diseases
Publisher: Philadelphia, W. B. Saunders
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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e those of Maisonneuve andOtis and their modifications. The most satisfactory instrument is the Otisdilating urethrotome. Maisonneuves instrument cuts from before backward, and is especiallyserviceable for the division of strictures of the deep urethra. It consists ofa hollow tube with a slit on the side corresponding to the roof of the urethra.Triangular knives of different sizes fastened to a wire shaft are passed alongthis central tube after its introduction into the bladder until the stricture isdivided. This urethrotome is supplied with a screw tip to which a filiformbougie may be attached. The principal objection to the use of this instru-ment is that it never divides the stricture completely unless a very largeblade is used, in which event much more cutting is done than is absolutelynecessary, and serious hemorrhage is apt to result. The latest pattern consists of a straight tunnelled shaft with a secondaryblade, the two being separated by means of a powerful screw. The cutting
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Fig. 53.—Dr. F. Tilden Browns modification of Maisonneuves urethrotome. blade is slipped along in a groove upon the central shaft. Attached to thehandle near the screw is a dial-plate. By this instrument the urethra may becut, or dilated and cut, to a caliber of 45 French. Another modificationis that of Dr. F. Tilden Brown, which consists in the adaptation of a slender 194 DISEASES OF THE MALE URETHRA. tunnel at the distal end, and of a handle set at an angle at the proximal end,of the instrument (Fig. 53). General anesthesia is only occasionally necessary in the performance ofinternal urethrotomy. In very nervous patients it is perhaps essential. Itmust be remembered, however, that when a general anesthetic can be avoided,especially in chronic genito-urinary cases, it is well to do so on account of thepossible evil effects of the anesthetic upon the kidneys. The author recog-nizes the fact that cocaine has something of an unsavory reputation in certainquarters, especially in urethr

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