The surgical diseases of the genito-urinary organs / by E.L. Keyes amd E.L. Keyes, Jr. ; a revision of Van Buren and Keyes's text-book, with one hundred and seventy-four illustrations.

  • Edward Lawrence Keyes
Date:
1903
Catalogue details

Licence: Public Domain Mark

Credit: The surgical diseases of the genito-urinary organs / by E.L. Keyes amd E.L. Keyes, Jr. ; a revision of Van Buren and Keyes's text-book, with one hundred and seventy-four illustrations. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

    60/886 page 38
    records 12 deaths in 170 cases, chiefly from uremia, septicemia, and hemorrhage. Treatment.—1. For mild injuries to the pendulous urethra ex- pectant treatment should be employed. Rest in bed, free purgation, and the internal administration of urotropin should be supplemented by a gentle injection twice a day of 3 to 5 c. c. of silver-nitrate solution (1: 2,000) or protargol (1: 1,000) into the anterior ure- thra. Catheterization is unnecessary and absolutely contraindi- cated. Extravasation or suppuration must be met by prompt inci- sion (p. 234). Three days after the symptoms have subsided the patient may be pronounced free from all dangers except stricture, against which he must be warned, and for which treatment is to be instituted on its appearance. The contraction usually begins within six weeks of the time of injury. Perineal rupture, however mild, demands immediate external section to avert deep resilient stricture. 2. Moderately severe anterior injuries represent, in a general way, slight lacerations, in which one may hope to avoid infiltration by keeping the urethra cleansed, as above, and preventing any contact of the urine with the wound. A small (]STos. 7 to 15 French) rubber or elbowed catheter should be used. The latter is the better instru- ment, as it can be made to force the cut-off muscle and to hug with its tip the uninjured roof of the canal. The catheter should be introduced every six hours and each catheterization followed by a nitrate-of-silver or protargol wash. 3. Perineal ruptures and all severe iti juries to the pendulous urethra call for immediate external urethrotomy and suture. Palli- ative measures, such as suprapubic aspiration (p. 209), catheteriza- tion, or the retained catheter (p. 210) cannot save the day. Aspira- tion may be useful to relieve the distention of the bladder and thus to gain time, but the retained catheter is worse than useless. It serves only to invite infiltration, while repeated catheterization is impossible as soon as congestion sets in. On the other hand, peri- neal section relieves the retention at once and for all time, while suture of the divided ends of the urethra affords the surest means of preventing resilient traumatic stricture. While opinions may vary as to whether stricture can be absolutely prevented by this operation—and I believe that in some cases it can—there can be no doubt but that the scar after operation is far less retractile, and either will cause no trouble or will prove amenable to treatment by sounds. The operation varies only in its details from the ordinary ex- ternal urethrotomy (p. 201). With the patient in the lithotomy
    digitised image 1
    digitised image 2
    digitised image 3