File:Clinical lectures on the surgical diseases of the urinary organs (1908) (14594083220).jpg

Identifier: clinicallectures1908frey (find matches)
Title: Clinical lectures on the surgical diseases of the urinary organs
Year: 1908 (1900s)
Authors: Freyer, P. J. (Peter Johnston), Sir, 1851-1921
Subjects: Genitourinary organs Urogenital System Urogenital System Urethra
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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ture, it may beadvisable to tie it in situ for a couple of days, the urine beingpassed beside it, at the end of which time the stricture willprobably have sufficiently dilated to permit of the introduc-tion of an instrument into the bladder. But here, again, 3—2 36 TREATMENT OF STRICTURE BY DILATATION it may be necessary to have recourse to a rigid Instrument,the tip of which, after traversing the stricture, may be guidedover the prostatic obstruction by the aid ol a finger intro-duced into the rectum. When we have to deal with a tight stricture, and for anyparticular reason, such as threatened retention of urine orthe 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
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I . i . N . 2, English scale; the soft conductor is then ■ 1 on into the bladder, where it curls up, followed through tin stricture by the metal dilator. The latter is then withdrawn and unscrewed, but the soft guide is left in the urethra. The next larger-sized metal dilator is then ed and passed in as before; and so on, till we have dilated tin strictun to Nos. 5 or 6, English scale, when the guide is withdrawn and a loosely-fitting catheter saj No. f, l tied in. Thi - proci dure 1 an, as ;i 1 ule, b« .1. • m d without :m ana >thetic, with the .ml <-1 a 5pei cent. solution of cocaint injected into tin anterior urethra it w .it\. \\ I lii- 1 en th( great advantage <»l this TREATMENT OF STRICTURE BY DILATATION 57 method 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, t

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