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Show INTRODUCTION OF THE CATHETERCF STONES IN THE URETHRA; 0F STONES IN THE URETIIRA. STONES may often form behind the stricture of the urethra, 'and prodigiously increase the irritation and the danger. In two cases, I have found on dissection that death was the con- fl Witt/in ~ '2 / / \t\ sequence of a small calculus lodged behind the stricture. The surgeons, in both instances, remained ignorant of the circumstance. It was indeed the circumstance of these cases which put me on using the probe or sound more frequently ; for by the common bougie the presence of calculi cannot be ascertained. The hand being now depressed so as to bring the catheter to the position G, still its point does not enter the bladder, unless, maintaining the footing and progress we have gained, the whole catheter be elevated, as in the outline C, and hih\i\\m w. , _ ', M then carried forward horizontally, not in the axis of the curve of the instrument. It will be in such distortions of the urethra, that the flex-e ible catheter may be used with advantage. \Ve either use the gum catheter without the wire, or we keep the wire in the catheter, and bend it so as to adapt it to the supposed obliquity of the canal; or, lastly, we withdraw the wire of In the case of a stone being behind the stricture, to introduce asmall probe, and push back the stone at little, allows the urine to flow; and if in this manner the patient can abide the delay, the use of the caustic may so far enlarge the urethra as to allow the stone to escape. But if the symptoms are pressing, and the irritation from the presence of the stone great, it will be better to out upon it, and we tract it. W'e may here remark, that if the urethra be opened with the knife, itwill quickly heal again, unless there be. a stric~ turc before this incision. In this case, having extracted the. stone, we must immediately commence our operations against the stricture, otherwise our incision may become fistulous, the catheter from about an inch, or an inch and a half, from from the difficulty the urine has to pass by the natural pass the extremity of the catheter, which gives some firmness to sageak. ' the instrument, and yet allows the point to be directed by Often a small stone lying behind the stricture, by irritating, the course of the canal, and to mount over any tumour or swelling which has produced the obliquity. Thus, if the obstruction be of the nature represented in the last plan, or if there should be a tumour or excrescence from that part of the canal where the vasa deferentia open, the catheter with a flexible point will surmount it, and glide into the bladder. causes ulceration, and lodges there until it half sinks into the perineum ; and sometimes, by slight injury, (as the perineum being hurt on the saddle), an inflammation, ulceration, and abscess, is quickly produced, and the stone is discharged by the perineum. When it lodges for some time in the urethra, * When foreign bodies have got into the urethra (how they get there is not the present inquiry), the urethra may be very freely cut, without danger 0f fistulous opening being the consequence. That only is occasioned by ob , atruction to the natural passage. VOL. 1. y 93 ' vmm M0991! - H |
