On the operation of opening the urethra in the perinaeum / by Thomas Bryant.

  • Bryant, Thomas, 1828-1914.
Date:
[1858]
Catalogue details

Licence: Public Domain Mark

Credit: On the operation of opening the urethra in the perinaeum / by Thomas Bryant. 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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    In uncomplicated retention of urine from organic stricture, where the urethra will not admit the passage of a catheter, this operation is never needed; the more simple, expeditious, and safe one of puncturing the bladder through the rectum having superseded this comparatively severe measure. I have no instance where it was performed, nor do I know of any where it should be selected, and it may, I think, be safely stated, that in none is it required. When retention is complicated with other injuries, such as extravasation of urine, laceration of the urethra after injury, either with or without injury to the pelvis, the operation of opening the urethra from the perir.seura may be advantage- ously employed. Extravasation of urine associated with organic stricture.— Commencing Avith the subject of extravasation of urine asso- ciated with organic stricture, I think it will not be disputed that the treatment of the surgeon should be directed to two objects: first, to let out the urine that is infiltrated into the tissue of the organs, as the perinseum, scrotum, penis, and abdomen, and thus prevent that fearful sloughing which is so well known to follow such infiltration; and secondly, to prevent its extension and recurrence, by removing the causes, and thus by some means procuring an easy and direct channel for the passage of the ui’ine. Before extravasation of urine could occur as a result of re- tention from organic stricture, it is tolerably clear that the urethra must have previously become obliterated, or at least impermeable. It is true this impermeability may be only temporary, being caused by some spasmodic action of the urethra upon the organic stricture; but more generallj'^ it is the result of the gradual contraction of the uretlii’al passage. If this latter is the case, as with some certainty it may be, asserted, there remains no doubt that the most simple, safe,, and perfect operation is the “ perineal section,^^ as by it thej urine extravasated into the peringeum is let out, a free passage] for the flow of the urine from the bladder is afforded, and thej chances of a fresh extravasation is prevented. If the stricturej can be divided at the same time, an advantage is undoubtedly! gained; but in many cases the infiltration of urine has so dis-j figured the parts, that much difficulty is experienced in tracing!