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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ument 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 effort should be made to close the perineal STRICTUEE OF THE URETHRA. 567 wound; if none of these conditions exists, the wound should be approx-imated by means of interrupted silkworm-gut sutures, leaving a smallopening at the lower angle for the protrusion of the gauze packing, whichshould be removed on the second day and not replaced. The packing ofa perineal wound for prolonged periods after operation is undoubtedly afrec(uent cause of delay in healing, the result of the formation of a fistulous
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Fig. 293.—Method of Passing the Catheter from Behind Forward, by Means of Urethral,Forceps, for Continuous Drainage after having Performed External Perineal Ure- throtomy. opening. The end of the catheter protruding from the meatus is con-nected with a rubber tube leading to a vessel under the bed, into whichthe urine drains from the bladder, the patient being thus kept dry andclean (Fig. 294). External Perineal Urethrotomy with a Guide.—In this operationthe membranous urethra is opened with the aid of an instrument thatserves to guide the surgeon by rendering the deep urethra easy of recog- 568 SURGERY OF THE PENIS AND URETHRA. nition by means of an incision in the perineum. Various instruments areemployed for this purpose, among them being the Symes staff, the groovedurethral staff, the Gouley tunneled catheter, the Thompson dilator, andthe whip or whalebone bougie used in conjunction with Horwitzs dilatingperineal staff. In addition to the guide there are required a scalpel,sci

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