Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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rol the hemorrhage; seek the torn parts of the urethra; sew them to-gether with fine catgut (No. 00); and fasten a catheter into the bladder.Such prompt treatment will nearly always remedy permanently thedamage. On the other hand, if urgency is not apparent and the injuryis treated by palliative measures, and the wound is allowed to heal in STRICTURE OF THE URETHRA 453 the natural manner, it heals with a resulting stricture often. The con-sequences of stricture I shall speak of at more length when describingthat form which is due to gonorrhea; suffice it to say that in the case oftraumatic stricture the patients symptoms are wont to be progressive,often running over years before he consults the surgeon. He will thentell of a gradual narrowing of the stream, of difficulty in micturition,accompanied often by burning and pain, sometimes of frequencysuggesting an associated cystitis. Sometimes there will be found asmall, thick-walled bladder, at other times a thin-walled distendedbladder.
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Fig. 277.—Perineal urethrotomy, cutting on the staff. The treatment of traumatic stricture is imperative and is by operation.The patient is placed in the lithotomy position. A staff is passed downto the stricture and is cut down upon through the perineum. In thesecases, cutting operations from within by the urethrotome are miproper,though a gradual dilatation with sounds of a traumatic stricture is suit-able, when sounds can be passed without violence. Unfortunately,_ how-ever, it may be impossible to pass any instrument through the strictureinto the bladder, because the course of the stricture often is extremelytortuous, even if it is not too narrow to admit the smallest instrument. 454 GENITO-URINARY ORGANS The operation of pcriyical section is our usual resort, therefore, and thismay prove to be an o)>erati()n of extreme difficulty. An assistant musthold the staff in the urethra so that the staff bulges the i)enneum. Thesurgeon then cuts down upon it, opens the urethra, and se

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