File:Clinical lectures on the surgical diseases of the urinary organs (1908) (14594317697).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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Fig. 26. bad urinary fistulge, or when drainage of the bladder throughthe perineum is necessary. Authors Operation. The following is the method of performing externalurethrotomy which I myself practise when the strictureis traversable by an instrument. 54 OPERATIVE TREATMENT OF STRICTURE The patient being anaesthetized arid placed in the lith-otomy position, if the stricture be a tight one I commencebv introducing a flexible filiform guide, on to which isscrewed a fine conical steel dilator (Fig. 15), No. 2 Englishscale. This Is passed on after the guide, which curls up inthe bladder. Tin- steel dilator is thru withdrawn and un-screwed, the guide being left in the stricture. The nextd dilator is screwed on, and passed as before; andso on, rapidly dilating the stricture till a fairly larg< -dilator—say, 6 or 8 E.—is reached, when the staff (Fig. 27)1- screwed on to the guide and introduced into the bladder. These staffs I had specially constructed with a short curve
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F11 and tapering beak, a female scivw being drilled in the endfor the reception of the male s< rev of the guide. It the stricture admit a fairly large stafl without dilatationthe above preliminaries are, of course, unnecessary, and thestaff is passed forthv ith. An incision a couple of inches long is then made in themedian raphe* over the site ol the stricture, the dissectionrapidl) < arried down through the perineum as far as the staff,and the stricture divided freely. The fistula are scraped,and all sin t communicate are laid open, theii margins1 lipped ofl w ith • I and un- healthy. A blunt then passed along the groove in ■ ,tt int.. the bladdc 1 t«. t.i« ilit.it. the introduction t thecatheter, and the stafl with the attached ;;u 1 <i< withdrawn. OPERATIVE TREATMENT OF STRICTURE 55 The tying in of the catheter and subsequent proceedings arethe same as described in the previous operation. When stricture is complicated by chronic cystitis withpurulent ammon

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