Identifier: surgeryitsprinci04keen (find matches)
Title: Surgery, its principles and practice
Year: 1906 (1900s)
Authors: Keen, William W. (William Williams), b. 1837 Da Costa, J. Chalmers (John Chalmers), 1863-1933, joint ed
Subjects: Surgery General Surgery
Publisher: Philadelphia and London : W. B. Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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and the application of a ligature isdifficult, the wound should be separated by means of retractors and the 566 SURGERY OF THE PENIS AND URETHRA. bleeding vessels seized by hemostatic forceps, which should be allowed toremain for three or four days. If the hemorrhage comes from the bulbousportion of the canal, this should be exposed by free incision and thebleeding vessels controlled by either ligature or purse-string suture. The question of drainage after a perineal urethrotomy is one of greatimportance. In such cases it is best to resort at once to continuouscatheterism. A full-sized soft-rubber catheter is passed and allowed toremain in the urethra until the new canal has formed about it. The effectof the continuous pressure exerted on the inflamed and congested urethrais most beneficial. Tenesmus is relieved, the bladder is put at rest, andurinary fever is prevented. Convalescence is assured without the forma-tion of a perineal urethral fistula. In cases in which combined internal
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Fig. 292.—External Urethrotomy.The manner in which the knife is made to enter the groove of the staff through the lower perineum. and external perineal urethrotomy has been performed and it is thenfound difficult to pass a catheter in the usual manner because of the roughand nodular condition of the urethra, the manipulation may easily be ac-complished by inserting a pair of long forceps, designed for removingforeign bodies from the urethra, through the meatus and making the jawsof the instrument appear at the perineal wound (Fig. 293). The proxi-mal end of the catheter is then caught and drawn from behind forwarduntil it protrudes an inch or so beyond the meatus. The vesical end isthen passed along a probe-pointed gorget, through the membranousand along the prostatic portion of the urethra into the bladder. When infiltration of urine into the perineum has occurred, or when aperineal abscess or sinus or a large amount of nodular tissue due to chronicinflammation is present, no effor

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