Identifier: textbookofoperat00bern (find matches)
Title: A text book of operative surgery and surgical anatomy
Year: 1878 (1870s)
Authors: Bernard, Claude, 1813-1878 Huette, Ch. (Charles) Norton, Arthur T. (Arthur Trehern), 1841-1912
Subjects: Surgery, Operative Surgery, Operative Surgical instruments and apparatus Surgical Procedures, Operative Surgical Instruments Surgical Equipment
Publisher: London : Baillière, Tindall, and Cox
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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e of the pros-tate has altered the direction of the urethra, catheterizationis not a simple matter, nor is it when a spasmodic contractionsupervenes in the muscles about the urethra, which we havedescribed above. It is impossible to say how each case is tobe dealt with, but some useful hints will be found in thearticle on stricture of the urethra. The most serious accident that can happen is the perforationof the wall of the urethra, and this may readily occur wherethe canal is narrowed or diseased, especially if the catheter beroughly or carelessly handled. A bridle of mucous mem-brane in the urethra, or at the neck of the bladder, may thusbe tunnelled, and, more likely still, the middle part of theprostate (Plate LXXVII., fig. 1). This is not, however, a very grave accident, for the beakregains the canal and enters the bladder. But of greatgravity is the perforation of the wall of the urethra, as theinstrument may travel on amongst the neighbouring tissuesalmost indefinitely. PI. 77
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AND SUKGICAL AXATOMY. 347 False passages are generally formed in the floor of theurethra near the bulb, and may give rise to hgemorrhages andthe infiltration of urine. Their presence may be suspectedwhen free bleeding occurs, or when the handle wanders awayfrom the median line ; the left index finger should at oncebe introduced into the rectum, where the beak may be foundlying in front of the muscular wall of the bowel, and in dan-gerous proximity to it. The prostate gland ought to be feltbetween the catheter and the rectum. Often false passages exist when the surgeon is called in torelieve a case of retention of urine, or to dilate a stricture.If he find out their situation he must carefully avoid them,keeping his finger in the rectum; and it must be confessedthat the operation in these cases is one requiring the greatestskill and patience. - i PLATE LXXVII. FALSE PASSAGES. — STEICTURE OF URETHEA.—PLASTIC OPERATIONS. — ENLARGEMENT OFMEATUS.—FIXING INSTRUMENTS IN URETHRA. Fig.

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