STONE IN THE URETHRA.
The lain may be intense owing to the spasm of the muscular fibres, and no attempt should he made at the mechanical removal of the stone till the urgency of the symptoms has been somewhat relieved by a very hot bath and a hypodermic close of Morphia. The spasm is immediately overcome by the administration of Chloroform, hut this should he reserved for cases where operative interference is necessary, and it is well to induce the patient to wait for the subsidence of the spasm, when by a powerful exi rulsive effort he may be able to drive the stone through the meatus.
When the obstruction is in the anterior portion of the urethra, the it ient should be directed when attempting to urinate to squeeze the glans and suddenly let go, reinforcing at the same time the contraction of the bladder by that of the urethral muscles, bywhich manoeuvre the stone may he squirted through the meatus. By a gentle kneading of the penis the stone may be assisted in its progress to the outlet. If the block is just within the narrow part of the urethra immediately behind the meatus or in the navicular fossa it should he delivered by slitting the meatus under a local amestbetic, and forcing it out by a gentle squeezing of the penis or by the introduction of a fine scoop.
When located farther hack in the penile part of the canal. a fine urethral forceps may lie tried, hut the attempt by this method is so liable tocause laceration and subsequent stricture that as a rule it will be better to cut down on the stone and remove it by a clean and free incision made into the floor of the urethra. A stone in the Membranous urethra should be ex tracted through a median perinea] incision, and often it will be best to push back a jagged stone in the penile urethra and deliver it through a perinea] wound, as then a permanent fistula is less likely to follow. After extraction of the calculus, the lips of the urethra] wound should be sutured, hut the skin wound should not be tightly closed, and a soft catheter tied in for a few days.
Before resorting to perinea] section an attempt may he made when the stone is situated far back in the membranous or prostatic urethra to push it backwards into the bladder by passing a large-sized blunt-ended bougie down the canal. It maw then be seized in the bladder by a small lithotrite and crushed, or dealt with by suprapubic cystotomy.