Identifier: surgicaldiseases00keye (find matches)
Title: The surgical diseases of the genito-urinary organs including syphilis
Year: 1889 (1880s)
Authors: Keyes, E. L. (Edward Lawrence), 1843-1924
Subjects: Urology Syphilis
Publisher: New York : D. Appleton and Company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ch cases, if a given instrument be introduced,the stream becomes smaller at once, and on the fourth day the sameinstrument enters with more difficulty, or perhaps will not pass at all.These strictures are frequently irritable as well as resilient, and alwayscall for internal urethrotomy in the pendulous urethra, combinedinternal and external urethrotomy, or perineal section in the deepurethra. 2. TkEATMEISTT of StEICTURE COMPLICATED BY— (a) False Passage.—False i^assage, as already stated, results fromrough or unskillful use of small instruments in an obstructed urethra.It may be due to forced catheter-ism, a barbarousprocedure, con-demned by itsname alone, whichconsists in passinga metallic cathe-ter up to the ob-stacle, and thenforcing it alongin the supposedcourse of the ure-thra, until urineflows through it,if haply this occurat all. It is notused at the pres-ent date. Falsepassages start fromthe bottom of la-cunae or from thefront face of astricture, from inabscess (Fig. 53).
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Pig. 53 (Dittel). front of the triangular ligament or from someWhen a surgeon makes a false passage, he may be 156 TREATMEXT OF STRICTURE OF THE URETHRA. unconscious of the escape of the point of liis instrniuont from thecanal, but he will soon perceive that it is behaving unusually. It doesnot glide along as if in a healthy urethra ; it is obstructed, but yetnot held in the same manner as if in the grasp of a stritture. Thepoint, moreover, seems often to be turned out of the median line, and,after the instrument has been introduced far enough to have reachedthe bladder, a rotary motion, imparted to the shaft, will show thatthe point is fixed in the connective tissue, and not freely movable,as it would be in the cavity of the bladder. In such a case a lingerin the perimeum, or, better still, in the rectum, will almost certainlyfeel the point of the instrument just outside of the wall of the gut,at the apex of the prostate, or perhaps lying between the prostate andthe gut. On withdrawi

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