Identifier: operativesurgery02brya (find matches)
Title: Operative surgery
Year: 1899 (1890s)
Authors: Bryant, Joseph D. (Joseph Decatur), 1845-1914
Subjects: Surgery, Operative Surgery, Operative
Publisher: New York : D. Appleton and company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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atory to sewing, a retrograde introduction . practiced only when the proxniial riiptiued end can the distal extremity of the ,n,t be foumrfor the puri)Ose of sewing. Suprapubic canal, as the instrument opening utilized for drainage, a. Extremity of intra- ^, , ., vesical catheter, i, J. Extremities of catheter in penis. is seen passing through it. c. Wall of blad.ler. The finding of the proxi-mal end, however, is often tedious and difficult, requiring the same care andscrutiny that characterizes its discovery in perineal urethrotomy without aguide (page 1252). After securing the proximal end repair can be effectedby sewing over a catheter introduced for the purpose (Figs. 1502, 1503, and1504). When the proximal end can not be found the blood and urine usuallywill readily escape, and the danger of further extravasation will be prevented.However, if plastic repair of the urethra be contemplated, or retention ofurine be likely to happen, it will be necessary to open the bladder above the
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1254 OPERATIVE SURGERY. pubis (Fig. 1312) and practice retrograde adheterism to prevent the latter;also to accomplish the former 2)urpose (Fig. 1505). The Precautions.—Carefully avoid injury of the structures by persistentefforts in passing a catheter or staff. Operate promptly to prevent needlessextravasation of urine and consequent sup))uration and fistula3. Extravasa-tion between the layers of the triangular ligament (Figs. 1374 and 1379)and beneath the superficial perineal fascia do not cause tumefaction untilafter rupture of the fascial restraints and the consequent extended infiltra-tion (page 1182). It should not be overlooked that a catheter, while pluggedwith blood, when introduced into the bladder through the proximal end ofa ruptured urethra will not permit urine to escape; otherwise it may bethought that the instrument has gone astray. However, if the eye of theinstrument be cleared by a stream of water, and other facts relating tocatheterism of the bladder already noted

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