File:Clinical lectures on stricture of the urethra and enlargement of the prostate (1901) (14597678279).jpg

Identifier: clinicallectures1901frey (find matches)
Title: Clinical lectures on stricture of the urethra and enlargement of the prostate
Year: 1901 (1900s)
Authors: Freyer, P. J. (Peter Johnston), Sir, 1851-1921
Subjects: Prostate Prostate Urethra Urethra Urethra Prostate
Publisher: New York : William Wood & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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t into the bladder. But here, again, itmay be necessary to have recourse to a rigid instrument, thetip of which, after traversing the stricture, may be guidedover the prostatic obstruction by the aid of a finger introducedinto the rectum. When we have to deal with a tight stricture, and for anyparticular reason, such as threatened retention of urine or 44 TREATMENT OF STRICTURE BY DILATATION the existence of great irritability of the bladder, it is thoughtdesirable to secure considerable dilatation at the first inter-view, there is no method of accomplishing this with greaterfacility and certainty than the following. A filiform bougiearmed with a screw on its proximal end is first passed throughthe stricture; on to this is screwed a fine plated steel dilator(Fig. 15), No. 2, English scale ; the soft conductor is thenpushed on into the bladder, where it curls up, followedthrough the stricture by the metal dilator. The latter isthen withdrawn and unscrewed, but the soft guide is left in
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Fig. 15. the urethra. The next larger-sized metal dilator is thenattached and passed in as before; and so on, till we havedilated the stricture to Nos. 5 or 6, English scale, when theguide is withdrawn and a loosely-fitting catheter—say No. 4,English, tied in. This procedure can, as a rule, be accom-plished without an anaesthetic, with the aid of a 5 per cent,solution of cocaine injected into the anterior urethra if neces-sary. We shall see later on the great advantage of thismethod of temporarily dilating a stricture under an anaestheticto enable us to introduce a staff for the purpose of performingexternal urethrotomy. Another method of facilitating the introduction of acatheter in difficult cases is to screw a straight, thin steel rod(Fig. 16), like a knitting-needle, on to a soft conductor. Thisis then passed through the stricture and a tunnel catheter TREATMENT OF STRICTURE BY DILATATION 45 slipped over the guide, which is then withdrawn, leaving thecatheter in situ. Finally, w

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