The intermittent rapid dilation of urethral stricture / by Otis K. Newell.

  • Newell, Otis Kimball.
Date:
1894
Catalogue details

Licence: Public Domain Mark

Credit: The intermittent rapid dilation of urethral stricture / by Otis K. Newell. 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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    All other strictures than the above class are either im- permeable, or those where from smallness of calibre practically no progress can be made by gradual dilatation. As to the impermeable ones I think all surgeons agree that the best treatment for them is external urethrotomy. In fact there is practically no other choice left to us if the stricture really is impermeable. For the remaining class I wish to offer a method which I have found very successful and satisfactory both to the patient and surgeon, but particularly to the patient, as it generally does not necessitate his interruption of work by any period spent in bed. The exceptions being cases where from very poor physique or condition of urine it is wiser to have some rest in bed. I have as yet met with only one such case, and that was where I recom- mended the patient to the hospital, because he was with- out proper home attendance, and suffering at the first visit from pain, haematuria, and partial retention. I re- lieved the partial retention, however, one week before his entrance to the hospital, by passing the then first size, No. 14 F., of my improved dilator. This dilator is simi- lar in construction to that described by me in this jour- nal of June 6, 1891 ; but has the important addition, for this method, of other dilatating or stretching staffs de- scending in size to 10 F., the latter being not much larger in calibre than the original metallic guide of 8 F. which is of course introduced first, or follows when nec- essary the small capillary bougie guide to which it may be screwed. To illustrate what I have called intermittent rapid dilata- tion let us take an extreme case and describe the method. We will suppose a patient comes passing his urine in the finest possible stream or even by drops ; that after a week or more of trial we fail to introduce the finest capillary guide. Our patient finally sends for us, with retention, and we are called upon to do the best possible thing for him. Under ether or local anaesthesia, and preferably local anaesthesia, we finally introduce the capillary bou-