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.

  • Edward Lawrence Keyes
Date:
1889
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.

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    force of the blow upon the perina?um. The caual may be entirely cut across, or more or less crushed transversely. Injury by violence to the ])orin;vuin involves to a greater or less extent the membra- nous uretlini and the bulb which partly overlies it. The immediate results are swelling, more or less escape of blood fi-om the injured bulb into the surrounding tissues, often haemorrhage from the ure- thral orifice ; dilKculty in emptying the bladder, perhaps amounting to absolute retention ; possible infiltration of urine ; perineal abscess and listula ; and finally traumatic stricture of the most obstinate character. Injury to the perinasum is not uncommon at any age from falling astride a fence, while walking on it, a wheel, while mounting a coach, etc. In boys a kick in the perinasum is often sufficient to damage the canal permanently, without apparently occa- sioning any immediate injury. Treatment.—If the patient can pass water and there is no infiltra- tion of urine, no attempt should be made to introduce an instrument into the bladder immediately after contusion of the urethra, for fear of making a false passage at the injured point of the canal. All means, local and general, must be used to keep down inflammation. If, however, there is retention, either immediate, or secondary from inflammation, and warm baths, local fomentations, and opiates do not relieve it, an attempt should be made to pass a soft, French olivary catheter very gently into the bladder. Failing in this, a long filiform whalebone bougie may be tried ; and, if this pass, a soft catheter, open at both ends (Fig. 26), may be made to enter the bladder pushed along upon it as a guide, or any tunneled instrument, soft or solid, guided in the same manner. If the bladder cannot be readily reached, perineal section should be at once resorted to, as this remedies the retention, and is the best treatment for the traumatic stricture which will inevitably follow. If a soft instrument can be introduced easily, it should be with- drawn after the bladder has been relieved, and reintroduced when necessary. If much difficulty is experienced in passing the catheter the first time, it should be tied in and left for a day or two, unless it causes the patient too much irritation, and then be withdrawn, cleaned, and reintroduced at intervals. As soon as the inflammation following the injury subsides, the passage of conical steel sounds must be commenced, increasing in size until the largest instrument is reached which the meatus will admit, and this must then be intro- duced by the patient himself weekly for a time, and then at appro- priate intervals for an indefinite period, to prevent recontraction of the traumatic stricture. If infiltration of urine has taken place, large, free, dependent in- cisions must be made in the scrotum and perinaeum, to let out the urine and prevent sloughing; the scrotum must be elevated, and qui-
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