File:Clinical lectures on stricture of the urethra and enlargement of the prostate (1901) (14781992804).jpg

Identifier: clinicallectures1901frey (find matches)
Title: Clinical lectures on stricture of the urethra and enlargement of the prostate
Year: 1901 (1900s)
Authors: Freyer, P. J. (Peter Johnston), Sir, 1851-1921
Subjects: Prostate Prostate Urethra Urethra Urethra Prostate
Publisher: New York : William Wood & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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rrhage in the introductionof the instrument, the condition of the patient is indeed apitiable one. If something further be not done to relieve hiscondition, he rapidly gets worn out from the severe pain andloss of sleep incident to the constantly-repeated catheteriza-tion. Under such circumstances the bladder must be drained,temporarily or permanently as the case may require, throughan opening made either in the perineum or above the pubes, 8 U4 OPERATIVE TREATMENT OF ENLARGED PROSTATE thus obviating the introduction of the catheter and giving thebladder complete rest. The method of draining the bladderby the perineum was described in a previous lecture in con-nection with stricture of the urethra. Should it be consideredadvisable to establish permanent drainage by this route, thiscan best be effected by the apparatus designed by Annandalefor this purpose (Fig. 39). To effect drainage of the bladder above the pubes the opera-tion is the same as suprapubic cystotomy for stone. Drainage
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Fig. 39. by this route may be permanently carried out by an apparatusdevised by Thompson (Fig. 40), by which a soft rubbercatheter is retained in the fistulous opening by means of asilver plate held in position by a belt round the waist and aperineal band. The other end of the catheter passes into arubber urinal strapped on to the leg. The considerations that must guide us in our choice betweenthese two operations may be stated thus: The perineal is amuch less serious operation than the suprapubic. When,therefore, drainage alone is required, and this is to be of atemporary character, and particularly if the patient be veryfeeble, the former operation should be selected. But if thedrainage is to be permanent, if there be suspicion of the OPERATIVE TREATMENT OF ENLARGED PROSTATE 115 presence of calculus, or when, from previous observation bythe cystoscope or otherwise, it is known or suspected that anoutgrowth of the prostate causing or accentuating the obstruc-tion exists, which is cap

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