| OCR Text |
Show i) 8~ . . . . 01' PIERLING THE bTIlICl'URL‘. or l~‘ls'l"JLA IN rsnzsco. suppuration was fairly established, the catheter was with chance is equal; at least, that we pass from the tract of the drawn from the wound, and introduced in the usual method . canal into the body of the penis. We must, therefore, contrive to cut the stricture as we withdraw the instrument, havs In a very few days the wound closed, and the fistulous open» ins; had entirely disappeared. FIG, 1. 8;; ing previously ascertained that it was in the canal. The instrument is introduced down to the stricture ; then the probe point A, fig. 2, is pushed onward through the callous part of the canal. In this movement it does not cut. It may enter with diliiculty; but this is the only difficulty in the opera~ FIG. 2. tion. It is then withdrawn; and, as it is withdrawn, it cuts and notches the whole length of the stricture. You then in- troduce a bougie, of a size to distend the passage fully. Here there is an immediate enlargement of the canal. In six hours the bougie being withdrawn, the urine is passed with a full stream; but we must persevere in the use of the bougie. 4 0F FISTL‘LA I}? THE I'EEINEL'M. WHEN the stricture of the urethra is of long standing, and progressive, there is in prooortion to the closeness of the stricu tag. 1. A, the incision; B, the [mini 0}" (/it: penis ; C, [/16 lament of the stricture. ture, an increase of muscular power in the bladder, attended with a high excitement of the whole extent of the urinary 0 Far. (O H. 9 A, ther lilio " bcpom‘z' ; B, C, the cutti' ng Imri'. trochar was passed from the incision into the urethra at 4 canals. The last efi‘eet of this continued. irritation is an ulceration ol the urethra behind the stricture, and an escape of the urine into the cellular membrane of the perineum. Should it happen that, by accident or sudden increase of up to the point of the penis ll. The origi nal plan of the: o )"7 ration was on the withdrawing of the stile ttc to haveiniircd "q the obstruction and Violent cll‘ort of the bladder, the urine is driven into the cellular membrane'by the neck of bladder and A this represents the second stage of the operation, when the. large bougie on the extremity of the canula‘ then Q I to have A i (' drawn it thus through the stricture, and finally introduced it :nto the bladder. Circumstances mad e this dillleult and ‘hc large seaton was introduced, and certainly answered , the " purL V pose extremely well. Wherever the bougie or caustic will not enlar're an intris cate stricture, which affects some considerable leie‘th of the canal, I have little hesitation in sayi ng that the strietcdre slw'l'd be cut ; but not perforated in the way here. attempted: 12;)1' when we try to push a stilette dow n upon a stricture, the of the perineum, the case comes to be attended with the utmost danger. The acrid urine flows under the intcguments, and stimulates the cellular membrane : sometimes it will pass into the loose cellular membrane of the scrotum, and distend it until it be nearly as large as the head. The constitution imme~ (liatcly sull‘ers. There is shivering followed by inflammation. The patient becomes irritable and low, and his pulse quick and small, accompanied with loss of appetite, thirst, and delirium; and the parts fall into gangrene or slough. Should it not prone fatal in this way. yet the inflammation and the C); a.» M", , it Am ' ' um |
