TREATMENT OF STRICTURE OF THE URETHRA.
General Management.—The successful treatment of stricture of the urethra is dependent not only upon the proper selection of surgical methods of management and skill in their application, but upon the manner in which the general management of the case is conducted. Careful attention on the one hand, or neglect on the other, may determine the success or non-success of surgical treatment. Thus dilatation may fail of its object because of irritability or resiliency of a stricture, which attention to certain details in the general manage ment of the case might avoid. Urethrotomy, divulsion, or perineal section may result fatally because of failure on the part of the surgeon to study carefully the condition of other portions of the genito-urinary tract and to appreciate the general and local conditions prevailing at the time of the operation.
In no disease of the genito-urinary tract is attention to genito urinary and sexual hygiene more essential than in the management of stricture of the urethra. Regulation of the diet, temperate habits, sexual moderation or abstinence, and avoidance of exposure to cold and wet, are all important. The use of tobacco should be interdicted as tending to induce general irritability and hypermsthesia. The writer believes, moreover, that it is especially irritating to the genito-urinary tract. Chilling of the feet and legs is apt to be especially injurious, its effect in producing acute hyperaemia and inflammation being precisely similar to its results in enlargement of the prostate, in which disease the disastrous effects of exposure are so well known. The administration of alkalies for the purpose of neutralizing the urine is essential in the majority of cases. When pronounced cystitis exists, certain remedies will be found beneficial by preventing decom position of the urine and consequently lessening its irritating prop erties. Boracic acid in ten- or fifteen-grain doses several times daily. naphthalin, creosote in small closes, oil of eucalyptus, benzoate and salicylate of soda, and in some instances small doses of turpentine, are useful for this purpose. In the author's experience the oil of eucalyptus in ten-minim closes has been of especial value;_ indeed, it is the urinary antiseptic par excellence. The activity of the skin should be promoted by Turkish baths and rubbings. The effects of
sudden atmospheric changes should be avoided by wearing warm flannel garments of uniform weight. Exercise should be taken in moderation; fatigue and over-exertion should be avoided; perfect rest may possibly be indicated.
Certain local measures are very essential in the management of stricture. A tendency to spasm and congestion at the site of the stricture may be prevented by the daily use of hot sitz-baths or the occasional application of leeches to the perineum. As a matter of routine, the writer advises his patients to take a hot sitz-bath nightly before going to bed. By proceeding in this manner, it will be found that the majority of cases of stricture will be much more tractable than under ordinary circumstances. In some cases of very tough, resilient stricture, the canal may be dilated much more readily if the patient be directed to take an injection of water as hot as can be borne night and morning. These injec tions should be kept up for half an hour at a time, and may advan tageously be made antiseptic by the addition of bichloride of mer cury, 1 in 20,000, or boric acid in saturation.
Where manipulations of the canal tend to excite urethritis, hot bichloride irrigations, as recommended for chronic urethritis, may be cautiously employed. The various balsamic preparations are of service in such instances.
Pain and spasm may be excited by each attempt at dilatation, in spite of the general measures already recommended. Under such circumstances, a small dose of morphine may be given hypodermi cally, by suppository, or by the month, a short time before the oper ation. When each operation tends to produce urethral chill or fever, the administration of opium has a decidedly conservative and prophy lactic effect. It will be found that in these cases of irritable stricture with a predisposition to urethral fever, thorough irrigation of the canal with a hot bichloride solution before and after the introduction of a sound or.before cutting operations, as the case may be, will gen erally obviate the difficulty. The author would particularly call at tention. to the advantages of this procedure, as it will certainly tend to prevent the septic element in the production of urethral fever. Quinine, jaborandi, eucalyptus, and diuretin are probably a11 ser viceable as prophylactics against chill, but eucalyptus is the most valuable.