The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects.

  • Keyes, E. L. (Edward Lawrence), 1843-1924.
Date:
1889, ©1888
Catalogue details

Licence: Public Domain Mark

Credit: The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    33/740 (page 11)
    tation of the penis is given by Louis Jullicn* in ]iis '^Tlicsis. Cu- badc has contributed f some points. When it is desired to remove the entire penis, including the bulb of the urethra, the method first used by Delpcche (1832), then by Lallemand, Roux, and Bouisson, is a good one, namely, as a first step in the operation, to split the raphe, inclosing one testicle in each half. Then Cabade's process may be employed, making a houtonniere in the membranous urethra^ incising the integument above and around the root of the penis, and taking ofl: each crus penis separately with the ecraseur passed through the boutonnure between the crura penis. Of course, if the bulb and a portion of the urethra can be spared for trans- plantation in the perinseum, so much the better. In such case a por- tion of the sides of the scrotum may be united above the orifice of the transplanted urethra in such a way as to form nymphse in front (as Howe has called them), which during urination direct the stream downward and backward. Howe first did this; later. Fowler J of Brooklyn. Instead of using the ecraseur upon the crura sejoarately, it is more surgical, but more difficult on account of hasmorrhage, after sjDlitting the scrotum and separating the urethra, to dissect out each crus penis separately, and remove it entire from its insertion along the ischial and pubic rami. With forcipressure forcejos this manoeuvre is perfectly practicable, and the amputation of the penis thus becomes complete. The inguinal glands, if implicated, should be removed. THE PEEPXTCE. Defoemities.—Practically, the deformities of the foreskin (phimo- sis and atresia of the orifice excepted) are unimportant. The prepuce is sometimes bifid, enlarged into a pouch, redundant, projecting half an inch or more beyond the apex of the glans, or only rudimentary from arrest of develojiment. Between the two latter limits it may be of any length, covering more or less of the glans. When the prepuce is deficient, the epithelium of the uncovered glans penis becomes hard and tough, more nearly resembling ordinary cuticle. Under these circumstances the sensibility of the part is diminished, but, at the same time, it is rendered less liable to become excoriated or to take on inflammation. Hence, absence of the prepuce is not to be re- gretted, and the operation for its restoral, postheoplasty, need not be touched upon. Dieffenbach performed it once on account of neu- ralgia of the glans penis. Excessive length of the prei)uce may demand operative interfer- ence. Moderate length alone, however, can hardly be said to consti- tute a defect, and may be left unmolested unless complicated by induration, thickening, or a contracted preputial orifice (phimosis), * Paris, 1873. f Bull, de la Soc. de Chir., tome iv, 187S, p. 500. X Annals of Anatomy and Surgery, September, 1881, p. 102.