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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The Wheelhouse probeis next introduced through themembranous and prostatic ure-thra until the neck of the blad-der is reached: this instrumentserves to guide the Teale gorgetthrough the perineal wounddown to the neck of the blad-der; as soon as this is accom-plished, the Wheelhouse probeand dilator are removed. Any remaining constricting bands, caused by the stricture, are incised anddilated by means of the Otis urethrotome; a soft-rubber catheter isinserted from the meatus into the bladder, and left in place untilthe continuity of the deep urethra has been restored. Bleeding is con-trolled by packing the perineal wound with iodoform gauze alongside thecatheter, using the gorget as a means of guiding the gauze clown to theneck of the bladder. The gauze should be allowed to remain for forty-eight hours, and then removed and not replaced. The perineal wound isclosed by means of interrupted silkworm-gut sutures, leaving a smallopening at the lower angle for the protrusion of the packing.
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Fig. 295.—Continuous Drainage.The patient is allowed to be up and to walk about. 570 SURGERY OF THE PENIS AND URETHRA. Perineal Puncture of the Membranous Urethra (ButtonholeOperation).—This method of performing perineal urethrotomy is some-times employed when it is desired to drain the bladder after an internalurethrotomy has been performed. A grooved urethral staff is passed, thepatient is placed in the lithotomy position, and a long straight bistoury,with a narrow blade, is inserted one inch in front of the anus, its backbeing turned toward the rectum; the instrument is carried steadily inwardin the median line until it reaches the groove in the staff inserted into theurethra, thus puncturing the membranous urethra; as the knife is removedthe incision is slightly enlarged upward, to make it of sufficient length to admit the index-finger. If themucous mem-brane of the canalhas not beencompletely divid-ed, the tip of thefinger is heldagainst the staffand a probe-pointed bistouryi

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