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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    coiisec[ueiic6^ unless some steps be taken to let out tlie urine, extravasation must follow, with all its dangers. Tlie question then for determination is—what is the best step to be taken ? And I answer most unhesitatingly, the perineal section.-’^ By such an operation the extravasated blood is let out, the chances of the extravasation of urine are removed, and, what is more, by Ihe passage of a catheter and its subsequent rest in the urethra, a more complete and per- fect cure is likely to follow than when the junction of the divided passage is left to chance, for it is from such cases that the w’orst and most intractable forms of stricture are produced, and in which a subsequent perineal division of the urethra is generally called for. Case, i—J. B—, set, 35, when jumping over a post injured his perinseurn ; the accident was followed by bleeding from the urethra and extravasation of urine. When admitted, catheterism was impossible ; the urethra was laid open in the perinseurn, and an instrument passed and left in for a week; the wound gra- dually healed, and the urine was drawn off regularly by a catheter, and upon the 17th day the perineal wound had ceased to afford any passage to the urine, and the man left well. When this rupture of the urethra is associated with other pelvic injuries, the argument in favour of the operation is much strengthened; the dangers resulting from extravasation of urine would in such cases be evidently magnified, and the necessity for an easy and direct flow of urine becomes more apparent. By this operation such a result is easily obtained, and, unless a catheter can be passed, it should be performed. When required in organic stricture.—Having thus briefly pointed out some of the cases in which the division of the urethra in the perinseurn may be called for, I pass on to the consideration of the cases of organic stricture in which such a ])iactice may be requii’ed, and without entering into the many points which have excited so much anger and dispute, I believe few surgeons will denv that there are cases where the