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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re should be no hurry in dilating by this plan. When the stricture isfully dilated a full-sized bougie is passed weekly for a month, then monthly INTERNAL URETHROTOMY 621 for six months, and then on quarter-days ; intelligent and clean patientscan do this for themselves, with strict injunctions to come up for advice ifunable to pass the instrument. (1 a) Continuous dilatation with bougies has been employed. Wherethe stricture is very small, only admitting a whip or filiform bougie, thepatient is kept in bed with the small bougie or catheter tied in; aftertwenty-four hours it will be found that a bougie one or two sizes larger canbe passed : the instrument must not fit tight if this method be adoptedor irritation will follow. In a few days the stricture will be large enoughto admit of intermittent dilatation. While the instruments are tied in,the urethra should be washed out twice daily with weak permanganatesolution. As this method is likely to cause urethritis, rigors, urinary fever,
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Fig. 211. I, Internal urethrotomy with Maisonneuves instrument. Grooved staff in urethra; filiform guide curled up in the bladder. Knife being passed. II, Showing the bulb (b), on the knife (a), which guards the normal urethra. &c, we do not advise its use; such cases are better treated by internalurethrotomy. (2) Internal Urethrotomy. This method is indicated for patients whohave not time to attend regularly for intermittent dilatation but can afforda week in bed (e.g. sailors between voyages); where the stricture is verytight, only admitting a filiform bougie, or where it is apparently impassable(in most instances such stricture will admit the passage of a filiform guidewhen the patient is anaesthetized); where the degree of urinary infectionis but slight (where there is marked cystitis, external urethrotomy is theoperation of choice) ; where the stricture is resilient and rebels againstsimple dilatation. The pit i nt is prepared with urotropin and by washing out the urethraas h

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