File:The surgical diseases of the genito-urinary organs including syphilis (1889) (14801171123).jpg

Identifier: surgicaldiseases00keye (find matches)
Title: The surgical diseases of the genito-urinary organs including syphilis
Year: 1889 (1880s)
Authors: Keyes, E. L. (Edward Lawrence), 1843-1924
Subjects: Urology Syphilis
Publisher: New York : D. Appleton and Company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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n thependulous urethra. This rule applies to the after-treatment in all thevarieties of cutting in the pendulous urethra. MAISONNEUVE3 URETHROTOME. This instrument is serviceable where it becomes necessary to incisestricture situated deeper in the urethra than four inches. It consistsof a hollow wire with a linear opening on that side which coiTespondsto the roof of the urethra. The knife, of different sizes, cutting frombefore backward, and from behind forward, with its exposed obtu.seangle always blunted, is attached to the end of a long stylet which fitsinto the groove of the instrument. The blade is prevented from slip-ping out by a projecting shoulder on either side, which runs insidethe hollow wire. Bumstead has advantageously modified the originalinstrument by making the knife run only to the beginning of thecurve, instead of up to the point, and by making the tube a littlemore solid. Bumsteads instrument has the blade on the lower side INSTRUMENTS FOR INTERNAL URETHROTOMY. 121
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(Fig. 42). This urethrotome is to be used with a scrcw-tii)pod fili-form bougie. It is proper to cut the meatus below, the pendulousurethra above, the curved urethra below. It is introduced, following its guide, anddepressed until the straight portion of thetube has passed the stricture. Then theblade is entered, pushed rapidly down, as faras it will go, and immediately retracted. The objection to this instrument is, thatif a large blade is used the healthy urethrais incised longitudinally, often for its wholelength anteriorly to the stricture; an acci-dent perhaps of no very great moment, butentirely unnecessary, while, if a small blade isused, the whole thick-ness of the strictureis not cut through.Voillemier has at-tempted to overcomethis objection byadapting a shield tothe blade from whichthe latter may beprotruded when thestricture has beenreached, but themodification is com-plicated and unsat-isfactory (Fig. 43).Another objection,applicable to all in-struments for incisingthe de

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