Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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lly be avoided if care and precision be used. Where thebleeding does not cease after the catheter is tied in, the urethra should beexposed from the perineum (external urethrotomy) and the bleeding-pointtied, or gauze packed round the catheter. Should bleeding take place inthe absence of a catheter so that the bladder becomes filled with clot (clot-retention), attempts should be made to remove the clot by breaking it up EXTERNAL URETHROTOMY 623 with a lithotrite and extracting with the evacuator, but usually underthese circumstances it will be necessary to open the bladder above thepubes, turn out the clot, and pack the deep urethra with gauze for twenty-four hours. (3) External Urethrotomy. The indications for attacking the stricturefrom the perineum are : (a) For impassable strictures, where not even a fine bougie can bepassed through under an anaesthetic. (b) In the presence of complications such as : (1) Extravasation of urine. (2) Perineal abscess and fistula. (3) Severe cystitis.
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Fig. 212. External urethrotomy, showing Wheelhouscs staff with the loop for-wards ; the urethra laid open and retracted ; the dark spot is the opening of thestricture amid granulations. Since to perform the operation by Symes method (with the shoulderedstaff) it was necessary that the stricture should admit an instrument ofNo. 2 size and therefore the more difficult cases were excluded, and sincewhere the shouldered staff can be used the method of Wheelhouse is justas simple, the former method has dropped out of practical surgery andonly the latter need be described. The principle of Wheelhouscs external urethrotomy is to expose thenormal urethra just in front of the stricture and trace the narrowed partof the tube hack with fine probes till the dilated portion behind the strictureiched, the stricture being divided as it is traced backward. Ill- patienl being in tin- lithotomy position, the straight grooved staff 624 A TEXTBOOK OF SURGERY of AVheelhouse is introduced down to the stric

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