Operative surgery . under the proper titles. Hypospadias results from a deficiency in the floor of the urethra. Theopening may be in the glans, or in the penile or scrotal portions. The firstform is the most frequent and the least important. The scrotal, with andwithout perineal involvement, is the next in point of frequency, and themost important of all. They may be designated, therefore, as balanic,penile, and scrotal hypospadias respectively. Mixed varieties of this deform-ity, such as glandulo-penile, peno-scrotal, and perineo-scrotal (page 1244),are sometimes seen. The Preparation.—Before
Operative surgery . under the proper titles. Hypospadias results from a deficiency in the floor of the urethra. Theopening may be in the glans, or in the penile or scrotal portions. The firstform is the most frequent and the least important. The scrotal, with andwithout perineal involvement, is the next in point of frequency, and themost important of all. They may be designated, therefore, as balanic,penile, and scrotal hypospadias respectively. Mixed varieties of this deform-ity, such as glandulo-penile, peno-scrotal, and perineo-scrotal (page 1244),are sometimes seen. The Preparation.—Before the operation the urine should be drawn andthe parts thoroughly cleansed. Chloroform anesthesia is advisable if nocontra-indications to its use be present. The penis is then confined to thestrip of wood (Fig. 1464,^?) by means of the pins passed through the cuta-neous borders of the organ, in order that it may be the better controlledduring the manipulative measures. UlKKATlUNS UN TUK SCK(/rLM AND IKMS. 1 lVr>. Fiu. 1464.—Instruments employed in repair of urethral defects. a. Small scalpels, b. Bistoury, c. Fine-pointed forcipressure. d. j\Iouse-tooth ami dis-secting forceps, e. Needle-holder. /. Short blunt-pointed straight and curved scis-sors, g. h. Single and double tenacnla. i. Steel sound, j. Flexible catheter, silver probe. I. Traction loops, m. Small straight and curved needles, clamps, o. Horsehair, silkworm gut, and catgut, p. Small strip ofboard and pins, to which the penis is confined during repair, q. Perforated shot. Gouleys Method (Fig. 14G5).—Gouleys method is especially applicableto the balanic variety. The Operation.—Make two longitudinal cuts at either side of the penis,flr, b and a, h, far enough apart to leave ample material for the new urethi-a;make cuts r, d and c, d, a. b, a quarter of an inch outside ; remove the integu-ment of the spaces bounded by these incisions; leave undisturbed the skinand mucous membrane included
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