DIAGNOSIS OF ORGANIC STRICTURE.
The diagnosis of organic stricture can only be made by instru mental exploration of the canal. An essential requisite is a moder ately capacious meatus. It is impossible to explore a canal of say a calibre of 40 French through a meatus with a calibre of 20. Otis' urethrometer was devised to overcome this objection, but it is by no means as satisfactory as the exploring bulbs. The best instru ment for exploration is the rubber boogie exploratrice of Guyon. This has a flexible shaft and a comparatively hard bulbous extremity • with an abrupt shoulder. Next in value come the exploring bulbs of Otis. With a good-sized meatus, these bulbous instruments enable us to detect points of contraction and tenderness in the urethra which will be overlooked entirely if the ordinary sound be used. There should be no hesitancy in incising the meatus if necessary for ex ploratory purposes. Indeed, meatotomy should be considered nec essary as a preliminary in both the diagnosis and treatment of ure thral disease in any case in which the meatus will not admit at least a 30 French.
With regard to the measurement of the urethra for diagnostic purposes, Dr. Otis' method of determining the calibre of the urethra by the circumferential measurement of the penis is fallacious. The
conditions governing the amount of blood in the organ and quently its size are so variable that the method is necessarily curate. When it is necessary to incise the meatus the operation should be performed with a blunt-pointed, straight-backed bistoury. There are several points aside from the existence of obstruction which may be determined by urethral exploration. These are: (1) The degree of contraction; (2) Its distance from the meatus; (3) By the withdrawal of the Bougie its shoulder may be made to impinge upon the posterior surface of the stricture, thus enabling us to deter mine the breadth of the obstruction; (4) The number of strictures. This is somewhat difficult at times, because one or more of the stric tures may be so small as to prevent the introduction of an instrument large enough to impinge upon deeper obstructions. This objection does not apply to the urethrometer ; (5) The condition of the urethra behind the stricture may be determined by examining the secretion withdrawn upon the shoulder of the instrument; (6) The amount of congestion present may sometimes be estimated; (7) Resiliency or irritability of the stricture.