OCR Text |
Show as rrswm m‘ PERIHE‘Q. sirnna'UON ror. FISTULA m PERINLH, tensive destruction of the cellular membrane is alarming even as a local complaint. We have only, in this event, to make a free outlet for the urine, by a simple but decided incision; to bathe the parts with emolient fornentations, and to support the patient. Generally, however, the ulceration of the urethra proceeds more gradually, and the parts inflaxning there is not this extensive infiltration of the cellular membrane: but an abscess is formed, which pointing in the perineum, is discharged, so that atterwards the urine flows partly through this iistulous opening, and partly by the urethra. Successive inflammations arise, the urine passes with more difficulty, and new abscesses are formed. The whole integuments of the perineum and scr0~ tum are inflamed, swelled, and full of irregular hardness. In most cases, to eradicate the cause by destroying the stric- \ "Tracy, y, "mun _ a"? mm . ., . um; ' «$5.» it ture, cures the disease ; for it is the difficulty of passing the " ‘ urine by the urethra which necessarily directs it into the ir: regular sinuses, by the side of the natural passage ; and which keeps up the irritation and the disease. If the stricture is an a tircly removed, and there is no great destruction of the canal, _..),__~.g+;v-mo-Me- ‘- the inflammation and hardness soon subside, and the ulcers close. rable extent, then the urine is driven amongst the cellular membrane of the perineum; tubes of condensed cellular ' _ .‘r ~=«-‘ r". .. ,_ "9a." _.. . "1",_,...--...w:. _ , membrane are formed; these are sometimes not confined to the perineum, but extend forward into the scrotum, or even The patient is placed in the position as for lithotomy. A ‘traixht catheter or sound, A, is introduced into the urethra, 1 ~ , - ' dOMltO 1110 Obbtmttlona B. " 1119 n a l)robe , C is introduced ) into the tistulous opening in the perineum. Often the straight probe will not follow the obliquities of the canal; it must be bent, and made if possible to hit upon the extremity of the backward to the neck of the bladder, or the extremity of the gut. This state of the parts requires a different operation-- one ill to suffer, and requiring dexterity and nicene ss in the catheter or sound. It cannot be made to touch the catheter, because the catheter is within the urethra, and above the operator. stricture. The diseased integuments of the perineum are now to be OPERATION. fizstrmzcnts.-A variety of catheters and probes, metall ic flexible catheters and bougies, ‘ ' a Syringe, Sponge, lint, &c. and the common pocketcasee wnacr St But when the fistulous opening is of long standing, and the urethra is callous, and closed almost entirely for a conside- will ,Mmm laid open down to the tract. of the urethra. If there IS one 51mm leading towards the stricture, it is to be followed; but if there are several, and they run deep backward, 1t 15 impossi- ' ‘ ‘ ' to follow them ‘ tow v a1'ds the Me or Imploptl . neck ‘ of the blad1 1 0502'. in this part of the operation, a (lcculed lllf'l:1011,aut a |