A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . position of the stricture shouldbe ascertained by means of bougiea boule. The operations upon the urethracoming luider the head of urethrot-omy may be divided into two gen-eral groups:Internal Urethrotomt andExternal Urethrotomy.—Internal Urethrotomy.—This procedure becomes the operation of election underthe following general conditions: 1st. Stricture of the meatus. All narrowings of themeatus sutflcient to be pathological are best treatedby cutting operations, asd
A Reference handbook of the medical sciences embracing the entire range of scientific and practical medicine and allied science . position of the stricture shouldbe ascertained by means of bougiea boule. The operations upon the urethracoming luider the head of urethrot-omy may be divided into two gen-eral groups:Internal Urethrotomt andExternal Urethrotomy.—Internal Urethrotomy.—This procedure becomes the operation of election underthe following general conditions: 1st. Stricture of the meatus. All narrowings of themeatus sutflcient to be pathological are best treatedby cutting operations, asdilatation in this region islikely to be both painfuland unsuccessful. 2d. In strictures anteri-or to the bulb, largeenough to admit thenecessarj instruments,under the following con-ditions: {a) When gradual dila-tation, tried for a sufficient length of time, has failed togive good results. (J) In case of so-called irritable strictures, namely,those followed by increased discharge, increase of spasm,urethral fever, etc.; also in the so-called resilient strict-ures. if) The presence of urinary fistulte and other suppura-. Fig. 4,<46. — TeevansModification ofMalsonneuvesUrethrotome. tive peri-urethral com])lications not requiring perinealsection. ((/) To admit the passage of instruments prior to opera-tions within the bladder, as in litholapaxy or before opera-tion on an enlarged prostate, to permit urethral drainage. There are two general types of internal urethrotomy : 1st. The operation cutting from before backward. Forthis the Maisouneuve and modifications of this instrument(Fig. 4846) serve as a type. Briefly described, the opera-tion is as follows: A filiform bougie is passed through the stricture andthe instrument is then attached to this as a guide. Theshaft is passed down to the anterior face of the strictureand the knife is then pushed forward until all stricturetissue has been divided. Tlie knife is then witiidrawninto its sheath, the instrument removed, and a
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