TREATMENT OF THE MALE URETHRA.
In slight injuries of the urethra, the practitioner must have in view the danger of subsequent stricture. This may be averted by systematic sounding during the healing of the wound. Hemorrhage may be controlled by pressure, the ice-bag, or the retained catheter: If the injury be at all extensive and a catheter can be readily passed, it should be retained in the bladder for a few days, after which the danger of extravasatiou will have subsided. Systematic dilatation should now be substituted for the retained catheter. If the penile urethra be extensively lacerated, a perineal puncture should be made for vesical drainage and the lacerated tissues should be stitched in layers over a soft catheter or a piece of rubber tubing. The peri neal tube may be removed at the end of a week. Primary union may be expected from this procedure.
In all urethral injuries great care should be taken in passing instruments lest the lacerated tissues be torn up and a false passage thereby made.
In deep urethral injuries a catheter should be carefully passed.
and retained for a week or more, after which dilatation should be be gun. If great difficulty be experienced in passing the catheter, or if the injury be severe, perineal section is indicated. If it be possible to suture any portion of the divided urethra, this procedure is ad visable. The author is of the opinion that perineal section is by far the safest method of treatment for the majority of cases of injury to the perineal portion of the urethra. Should extravasation of urine be suspected perineal section is imperatively necessary.
In the management of all cases of urethral injury, the strictest attention should be paid to asepsis and antisepsis. The most im portant practical point in connection with urethral traumatism is the fact that stricture of the canal often follows injuries which are so trivial as to attract little or no attention at the time of their inflic tion. Careful attention may obviate this untoward result.