File:The principles and practice of surgery (1916) (14763917332).jpg

Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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hreds of mucosawill remain, joining the two por-tions, and give a useful clue.Otherwise the upper part is found by patient search and by remembering that the urethra appearswhite when the wound is sponged clean of blood, which is veryessential in this operation. Where this method fails the bladder isopened above the pubis and a catheter passed in a reverse directiondown from the bladder to show the orifice. Having identified theproximal part, a soft catheter (8 to 10) is passed the whole length of theurethra into the bladder, badly crushed portions of urethra cut away,and the freshened ends carefully sutured together with fine, plain catgutround the catheter; good apposition is essential. The superficialwound is closed in layers and the catheter retained from eight to tendays. Where the operation is done early before much extravasation hasoccurred flu- wound will heal well, usually by practically first intention.Care i- Deeded to keep the patient under observation and pass bougiesa 39
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Fig. 207. Rupture of the urethra in the perineum, showing penis and scrotum black and distended with blood and urine, which is spreading into the lower abdomen. 610 A TEXTBOOK OF SURGERY at intervals for a year or more to make quite certain that stricture does notfollow. Some surgeons drain the bladder above the pubis after suturing theurethra, but as this does not prevent a little urine trickling down i he urethra,and as the results of suturing over a catheter are so good, we do not advisethis complication. When the patient only appears late with gross extrava-sation in the perineum and abdomen which is infective and causing spreadingcellulitis, suture of the urethra is out of the question; free incisions aremade in the perineum down to the laceration and the bladder drained bya tube ; incisions in the scrotum and lower abdomen may also be needed.At first free drainage is all that can be done, but when the inflammationsubsides attempts are made to reconstruct the urethra, either by i

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