Tapping the male bladder in operations on urethral fistulae / W. Mitchell Banks.

  • William Mitchell Banks
Date:
[1878]
Catalogue details

Licence: Public Domain Mark

Credit: Tapping the male bladder in operations on urethral fistulae / W. Mitchell Banks. 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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    the prostatic portion of the urethra. It was, in fact, the upper end of the original large cleft which extended into the rectum, and which alone had failed to unite. Probably the passage of the first hard motion tore it open. I waited for a month or two to let this aper- ture shrink down to its smallest size, the patient in the meantime drawing his water off regularly, so as to prevent any from flowing through it. I then found the hole was a trifle too large to be quickly cured by hot wires or similar treatment, and so performed a small operation for its closure. With the patient in the lithotomy position I dilated the anal orifice with the small end of a duck-bill speculum, and then paring the edges of the aperture brought them together with three silver sutures, introduced by means of a hollow travelling needle. This does not take long to tell, but it took about an hour to do, on account of the very confined space in which all the manoeuvres had to be performed. For about ten days the patient carefully drew off his water, even doing this twice or three times in the night, so that his bladder should never get distended and so perhaps lead to his involuntarily passing some water through the urethra. At the end of that time the stitches were withdrawn, and an experimental micturition being made not a drop was found to escape, and the patient pronounced the whole urethra u as tight as a drum.” He left the infirmary in January of this year to resume his employment in all respects as sound in the urinary tract as ever he was, and extremely grateful for having been rescued from his former deplorable plight. The first point to be noticed about this case is the rarity of fistulas so large as this. With the small fistulas which are found in the “watering-pot” perineum connected with the ancient and gristly stricture one is sufficiently familiar, but the size of this one exceeded anything I have seen before. Seeing that there were two openings, one within the rectum and one on the perineum, it is not improbable that the tissues between the membranous part of the urethra and the last part of the rectum were very rotten, and that, when they were cut open, the weakened urethra gave way for some distance. Whatever be the explanation, when the man came under my care, there is no doubt that when a bougie was passed into the bladder quite an inch of it could be seen lying at the bottom of a very deep cleft, part of which ran up into the rectum. From the first I con- fess I had no hope except in an operation, but the dressing it and touching it with nitrate of silver amused the man, while meantime his general health was getting much better, and he was becoming an adept in using the catheter and passing his water through it on his hands and knees. It is undoubtedly to this power that he owed the success of the second or minor operation. With the exception of an operation, I cannot think of any treatment likely to have been of the least service except the use of the galvanic wire. This is most strongly recommended by Sir Henry Thompson and other writers of great practical experience in urinary diseases, and is un-