A manual of operative surgery (1910) (14760262801)

Identifier: manualofoperativ0001trev (find matches)
Title: A manual of operative surgery
Year: 1910 (1910s)
Authors: Treves, Frederick, Sir, 1853-1923 Hutchinson, Jonathan, 1859-1933
Subjects: Surgical Procedures, Operative Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School



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d. CHAPTER XXIII OPERATIVE TREATMENT OF STRICTURE OF THE URETHRA to the meatus, which are quiteby incision with a blunt-pointedby the regular passage of a large- Cases of stricture at or closeexceptional, should be treatedbistoury or tenotome, followedsized bougie (if possible,No. 25 French). In everyother case of stricture thetreatment by gradual dilata-tion with flexible bougiesshould be tried. Only whenthis fails—either from imper-meability to the instruments,from extreme resiliency ofthe stricture or irritabilityof the urethra—should anoperation be resorted to.The best operation, providedthat a fine bougie can beintroduced as a guide, isunquestionably internal ure-throtomy. If no bougie,however small, can be passedthrough the stricture, theoperator may be obliged toperform Wheelhouses opera-tion (page 645). Finally, he may be compelled in the worst andmost neglected cases to make an artificial opening into theperineal urethra without attempting to cure the stricture (Cocks 637
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FIG. 170.—METAL STAND WITH TUBES OFSTERILISED OIL FOR USE IN CATHETER-ISATION. EACH TUBE IS PLUGGED WITHWOOL. 638 ABDOMINAL OPERATIONS (part 11 operation). It will be seen that internal urethrotomy isreserved for a small percentage of cases (those in which gradualdilatation fails), whilst external urethrotomy should be regardedas the last resort of the surgeon, though it should be noted thatsome surgeons do not so regard external urethrotomy, andperform it in preference to the internal operation. The former,however, is certainly attended with greater risk, and alwayscauses a fistula for a time, pccasionally for months or years.Convalescence from internal urethrotomy, on the other hand,is a matter of a week or two. It has been claimed for external urethrotomy that the chancesof a permanent cure (i.e. without involving the subsequent useof bougies) are greater than after the internal operation orthan after gradual dilatation.* It is doubtful if such a claimis justified. Now and then i