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Show 86 OPERATION I'OK FIS'IL‘LA IN I‘thlh'iiO'. fair wound, is to be wished for. A diflident groping and cutting, without any precise View, keeping the patient for hours, I may venture to say, on the table, may be (and I knmr has been) followed with inflammation, which in this exhaust~ ed and irritable state of the patient has proved fat/air. In severe operations of this kind, there will often follow, in consequence of the continued pain and irritation during the operation, "11 Luess and vomiting, and pain of the belly and 511citing of the testicle. 1 The most difficult part of the Operation is to iind the urethra behind the stricture. The bulb and spongy body of the urethra is now no mark. The parts are massed together by inflammation, and new divisions are formed by fistulous tubes and sinuses. The urethra is not like an artery, gaping and open when cut. On the contrary, I have seen the operator .7..--.-.~ 1 I 4113th "Wilt it cut it in all directions, both in this and in other operations, L‘s": week?" without being able to discover its cavity. If we should fail. in attempting to introduce the probe into the ii>tulous cont munieation, we must cut upon the stricture and the point of the stall", and now aeain searching 111t1 the probe for the continuation of the canal to11u111s the‘ bladder and having found it, introduce the catheter from the pomt of the penis, past the stricture, down into the bladder. The 1elief f1on1 the two dischaiee of urine by the catheter is immediate. ']he paits consolidate and heat over the cathe- 87 BUT I have now to describe a still bolder and more decided operation. It often happens that in these diseases of the perineum, the urine obtaining a free discharge by the fistulous opening, the original stricture is more and more contract- ed, and a considerable part of the canal is totally obliterated. This contraction and increase of the length of the stricture is no doubt accelerated by the successive extension of the inflammation in the perineum; and very often in this complicated state of the disease, the‘1e is a huge (111315y swelling of the intern- ments of theperineum, 5:1tat part oi 11inch it new better to take away by a double incision in the first pait of the operation. In this opeiation, one longitudinal incision in the length ot' the diseased integunients 01';the perineum, 01 tne, ineludinga poition 01 the diseased skin, 111ay be necessary. In this the state of the parts must be our rule and guide. Now the parts are to be pretty flt't‘iy dissected, while we endeavour to make distinct the bulb ot the urethra. The lis- tulous opening into the urethra is next to be sought for ; and a staff, or sound, or catheter, having been introduced into the urethra, down to the upper part of the stricture, the tract of the diseased urethra, and the point of the stafi‘, is to be explored; and if the urethra proves entirely diseased for some length, it is to be cut out. Now a bongie of the largest size is to be introduced from the wound, into the bladder, and 21110- ter, the wound being {i‘pt open until it craniilatcs from the ther from the extremity of the urethra down to the wound. 'lhe parts are to be slichtiy dressed, and the patient put to bottom. bed. In a few days, when the granulations shall have covered the ,,.,,..1._ --~ 7 or CUTTING our mnr or THE URE'l‘lIRA. catheter, andthc tract in which it lay is consolidated, it may be withdrawn, and :1 00111111011 bougie introduced. As far as I have been able to olrerve, the urine will not make its way into the perineum again, as long as the urethra is free. After a. fewd days, when suppuration has taken place, and the grannlations are sprouting 11p about the bougie, itis to be 11 1t1(t1‘aw1, and the cathetei introduced along the whole length of the uretlua; over \1inch if it be kept steady, and in a good situatiion, the parts \1 ill soon healI. After the first dressing, when we find that the inflamma*‘ Many of the cases which we hear ofin general, "here a man dies after the operation for n ilsilllit, are cases where. the parts are in :1 gauge-nous stair, as I have described in the first instance, and no blame should att-"xfh to the surgeon. tion is not likely to run to any dangerous degree, we must dress with a stimulating ointment, on sn‘ps of lint, and over this put a warm poultiee, 11 ,‘nieh will promote healthy gratin. lotions. W E: .mm H |
