Surgery, its principles and practice (1906) (14773421755)

Identifier: surgeryitsprinci04keen (find matches)

Title: Surgery, its principles and practice

Year: 1906 (1900s)

Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed

Subjects: Surgery General Surgery

Publisher: Philadelphia and London : W. B. Saunders

Contributing Library: Francis A. Countway Library of Medicine

Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

Text Appearing Before Image:

the cutaneous covering at the base of the glans; this shouldencircle one-third of the neck of the penis. The skin-flaps are now dis- MALFORMATIONS OF THE URETHRA. 499 sected back until the lower third of the penis is laid bare. The flaps arewell retracted, and the corpus spongiosum, containing the urethra, isdissected from its bed between the corpora cavernosa. It now remains to establish a groove on the under surface of the glans,or a tunnel may be made through that structure for the reception of thedislocated urethra. This may be effected by pushing either a trocar or anarrow straight bistoury through the structure of the glans in the direc-tion of the natural channel, dilating the canal thus constructed by meansof forceps. Or a lateral incision may be made along the edges of theurethral groove, on the under surface of the glans, forming two flaps;the resulting cleft should be sufficiently deep and commodious to ac-commodate the transplanted portion of the urethra. Finally, the edge

Text Appearing After Image:

Fig. 282.—Becks Operation for Balanitic Hypospadias (Fowler).A, Lines of incision; B, tunneling for the urethra. of the urethral orifice is grasped by means of a delicate pair of catch for-ceps, drawn up to the top of the glans; and anchored by means of foursilk sutures. The flaps forming the glans are united around the urethra,and the lateral skin-flaps are likewise approximated. It is well to leavea catheter a demeure in place for a few days. Various modifications of the technic for restoring the penile urethrahave been suggested from time to time. Probably one of the mostsatisfactory methods is that devised by Thiersch, and originally em-ployed by him for the relief of epispadias. He first frees the penis fromany existing adhesions, corrects the cur\^ature, and reconstructs theglandular urethra in the manner previously described, after which heendeavors to form the missing portion of the penile urethra. 500 SURGERY OF THE PENIS AND URETHRA. Before attempting to restore the urethr

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1906

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