. Surgery, its principles and practice . on and explora-tion of the fistulous tract; forthe latter purpose a metalbougie is inserted into theurethra and a Sims speculum introduced and the rectum inspected. The opening can usually be readilydiscovered and explored either by means of a fine probe or a filiform bougie. Treatment.—In this form of fistula a spontaneous cure is rarelyeffected. In recent traumatic cases or following suppuration that is notdue to a tuberculous infection a cure may follow removal of any existingurethral obstruction, and, by means of continuous catheterism, protectingth
. Surgery, its principles and practice . on and explora-tion of the fistulous tract; forthe latter purpose a metalbougie is inserted into theurethra and a Sims speculum introduced and the rectum inspected. The opening can usually be readilydiscovered and explored either by means of a fine probe or a filiform bougie. Treatment.—In this form of fistula a spontaneous cure is rarelyeffected. In recent traumatic cases or following suppuration that is notdue to a tuberculous infection a cure may follow removal of any existingurethral obstruction, and, by means of continuous catheterism, protectingthe fistula from the entrance of urine, intestinal gas, and fecal operative interference has resulted in a large percentage of failures,it is best first to resort to palliative measures. Fistulas resulting from atuberculous process or malignant growths are not amenable to experience has shown that the employment of stimulants, such assilver and copper, or the use of the actual cautery, is of little Fig. 303.—Tuttles Operation for fistula and wound in the rectum closed. 586 SURGERY OF THE PENIS AND URETHRA. The indications are twofold: first, to remove any obstructions of theurethra that may exist, and, second, to obhterate the fistulous can best be accomplished by the technic suggested by Tuttle. Tuttles Operation.—The patient is placed in the lithotomy incision is made in the median line of the superior wall of the rectumfrom behind forward, and carried upward, dividing the urethra, andthence outward, incising the perineum, until the junction of the perineumand scrotum is reached. By means of scissors the cicatricial tissue sur-rounding the urethra is trimmed away, after which the intestinal wall is dissected for three-quarters of^ an inch beyond the fistula, and likewise freed for a half-inch oneach side. Next a flap is dis-sected from the soft tissues fromeach side of the urethra larg
Size: 1650px × 1515px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, booksubjectg, booksubjectsurgery
