. Surgery, its principles and practice . e guide be-fore the incision iscompleted. In order to em-ploy the Symes staffit is necessary thatthe stricture shouldhave a caliber of sixmillimeters; if this Fig. 294.—Continuous Catheterism in the Recumbent Posture. is the Case, it IS much quicker, moresatisfactory, and easier first to stretch the stricture by means of modifiedrapid dilatation, and then either to employ the Thompson instrumentas the guide or to make use of the full-sized grooved urethral staff. Thetechnic of an external perineal urethrotomy performed by means of theSymes staff, the Th
. Surgery, its principles and practice . e guide be-fore the incision iscompleted. In order to em-ploy the Symes staffit is necessary thatthe stricture shouldhave a caliber of sixmillimeters; if this Fig. 294.—Continuous Catheterism in the Recumbent Posture. is the Case, it IS much quicker, moresatisfactory, and easier first to stretch the stricture by means of modifiedrapid dilatation, and then either to employ the Thompson instrumentas the guide or to make use of the full-sized grooved urethral staff. Thetechnic of an external perineal urethrotomy performed by means of theSymes staff, the Thompson dilator, or the grooved urethral staff is prac-tically the same in each instance. External Perineal Urethrotomy, Using the Thompson Dilator as aGuide.—Ether is administered, a filiform bougie is inserted, and theThompson dilator threaded over it and passed into the urethra as far asthe neck of the bladder. Modified rapid dilatation is then performed, andthe blades of the instrument left separated just sufficiently comfortably. STRICTURE OF THE URETHRA. 569 to distend the urethral walls and hold the canal firm and steady. Anassistant holds the staff up against the abdomen, in the median line, andhooks it up against the pubic bone. The patient is placed in the lithotomyposition. The scrotum is drawn up out of the way, and the instrumentso held that it can readily be felt in the membranous urethra by palpationof the perineum. An incision is now made along the median raphe, fromthe attachment of the scrotum down to the region of the sphincter ani,dividing the skin and superficial and deep perineal fascia, exposing theaccelerator urinse muscle at the bottom of the wound; the tendinousraphe is next divided, bringingthe urethra into view, which isthus fixed and distended by theaid of the dilator. A tenaculumis then passed on each side ofthe staff into the urethra, andplaced in the hands of the as-sistants who are holding thelegs, directing them to makegentle traction, which
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