The remote results of structural lesions ('interventions sanglantes') in urethro-stenosis / by Reginald Harrison.

  • Harrison, Reginald, 1837-1908.
Date:
1900
Catalogue details

Licence: In copyright

Credit: The remote results of structural lesions ('interventions sanglantes') in urethro-stenosis / by Reginald Harrison. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the discharges from a wound which can only be imperfectly treated antiseptically. I am not aware that the influence of urine-drainage and irrigation in relation to the healing of wounds of the urethra and the kind of scar-tissue that results have ever been adequately discussed in connexion with the operative treat- ment of urethral stricture. With the view of meeting what I consider to be causes of failure and recurrence following some operations, I published3 a series of cases and observa- tions where I had combined the principles of internal and external urethrotomy in the treatment of certain forms of urethral stricture which on the whole have afforded good results. I shall best illustrate this practice by a typical case which was recorded and watched for a considerable number of years. A man, aged 51 years, whom I saw and operated upon in 1890, had been the subject of a stricture with a strong tendency to contract for some years, and had undergone no less than six operations for it, including a divulsion by Holt’s method, and five internal urethrotomies at various intervals and places. For some months before I saw him the stricture had been contracting and closing in spite of the patient’s well-directed efforts with suitable bougies to keep it open. Straining to urinate was constant and prevented continuous sleep, and there was some cystitis with probably pyelitis. I performed an internal urethrotomy with Teevan’s modification of Maissonneuve’s instrument, as I thought that the latter might not stand the strain put upon it by the cartilaginous character of the tissues which had to be divided. This being done I passed a full- sized grooved staff (No. 1Z English) into the bladder. As the staff was evidently gripped in the deep urethra the patient was placed in the lithotomy position and I divided in the median line from without inwards such contracted tissues as remained. I thus opened the urethra and found by passing my finger first into the bladder and then hooking it forwards along the urethra in the direction of the penile orifice that the walls of the canal had now been rendered free and unresisting. A full-sized gum-elastic drainage-tube, such as I have elsewhere described8 was passed into the bladder through the wound and retained. The parts were washed out with a solution of perchloride of mercury (1 in 6000). The stiff drainage-tube was withdrawn on the sixth day and a soft rubber one fitted with a tap for the voluntary withdrawal of urine was substituted which was worn for a fortnight longer and then finally removed, when the wound soon healed. Ten years have now elapsed since this operation was practised. The patient remains in good health and suffers no further inconvenience from his urinary organs than having occasionally to pass a full-sized bougie for himself. It may be thought that the retention of a catheter in the bladder for some time after an internal urethrotomy has