File:A system of genito-urinary diseases, syphilology and dermatology (1893) (14763839322).jpg

Identifier: systemofgenitour01morr (find matches)
Title: A system of genito-urinary diseases, syphilology and dermatology
Year: 1893 (1890s)
Authors: Morrow, Prince A. (Prince Albert), 1846-1913, ed
Subjects: Skin Syphilis Genitourinary organs
Publisher: New York : Appleton
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ly unknown. I shall therefore employ the termexternal urethrotomy to indicate those operations in which the urethra isopened through the perineeum upon some sort of guide. It will only benecessary to describe the two chief varieties of this procedure, a. Symes Operation.—The instrument needed will be a grooved staff (Fig. 16) with a narrow terminal part which is passed through the stricture. When this narrow portion joins the shaft there is a shoulder which, when the instrument is in position, rests against the anterior face of the stricture. The groove of the staff runs to its extreme tip. A scalpel, a probe, a broad-grooved director, or, better, a Teales probe20 514 STRICTURE OP THE URETHRA. gorget (Fig. 17), and a catheter, are all that will be required. The opera-tion is described as follows (Treves, Operative Surgery, vol. ii, page 626):The patient is placed in lithotomy position, and the staff is introducedwith the care already advised in performing that operation. An incision
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Fig. 16. is made precisely in the median line of the perinseum, and the knife is sodirected that its point shall hit the shoulder of the instrument. The surgeon must convince himself that this portion of the staff islaid bare. He then engages the point of the knife in the groove of thestaff, and, keeping most carefully to the groove, thrusts the knife towardthe neck of the bladder until he has divided the whole of the stricture.A director or probe, or Teales probe gorget, is now introduced along theconvexity of the staff into the bladder, and the staff is removed. A gum-elastic catheter may then be passed into the bladder through the penis,and be guided by the director or probe gorget aided by the linger insertedinto the wound. Should the irritability of the bladder prevent the retention of a cathe-ter, a tube should be passed into the bladder from the perinseum, andshould be retained in position by tapes, Symes curved catheter may be employed for this purpose, or a por-tion of a gum-

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