The following combination may be used to prevent rigors and septic fever: R . Urotro n. gr.
Quinina: Sulphat is gr. vj.
Pulveris Doveri gr. xii. Misce.
Fiat pnlvis. dtiffe tales vi. Signa.—" One to be given immediately after the operation, in a tablespoonful of whiskey, and repeated in tltree hours, and again in six hours if necessary." For lnumorrhagc from the deep portion of the urethra, firm pressure and an Ice-hag or the crutch of Otis may be used. If very severe, external urethrotomy should at once be performed, and the wound tightly packed with gauze around a catheter, and Adrenalin may be locally employed. If from the penile portion of the canal, a firm catheter may be passer], and a bandage placed around the penis so as to compress the bleeding surface against the instrument.
Extravasation of urine, urethral or septic fever, pytcmia, cystitis, urethritis or kidney trouble must be dealt with promptly they show themselves.
About the seventh day the patient should have a well-lubricated hougie (No. 12 English) passed through the urethra, and he should be confined to bed till this period. About every 3 days for the next fortnight will suffice for the passage of the hougieJarger instruments up to No. i6 E. being used, and at the conclusion of the treatment the patient is taught to do this himself, the after-management being exactly the same as if the operation of intermittent dilatation had been carried out.
I frotropine or other urinary disinfectant should be administered for several days before the operation, especially in all cases where the urine is foul, and in had septic cases the bladder should be drained through a perineal wound.
External operation is indicated in cases of imper meable stricture, in those in winch urinary fistulae exist, and where all other methods have failed, and in traumatic strictures with extravasa tion of urine.
Syme's operation is the most suitable when an instrument, No.5 E., can be passed through the narrow stricture into the bladder.
A staff, grooved upon the convexity of its curve, which is about the size of a No. 5 English catheter, is passed through the stricture into the bladder. The groove is in the middle of the curve. and this ends abruptly
in a broad shoulder which marks the beginning of the anterior portion of the staff, which is about the size of a No. to English from the shoulder to the handle. With the ainiesthetised patient in the lithotomy position and the narrow grooved part of the staff through the stricture, the broad shoulder being held against its face, the operator cuts down on it from without by a median incision, enters the groove with his knife. and divides the stricture in its whole extent from behind forwards, after which a catheter is passed upon a probe acting as a guide into the bladder. A fine gorget may be used to incise the urethra in the direction of the bladder. A catheter is tied in through the perineum for the first 3 or 4 days, and a bougie or sound passed every second or third day till the perinea] wound heals. By Syme's method a Syme's catheter fitted with a stopcock was tied in through the external meatus, but this part of the method is not much used nowadays.
WIteelhouse operation is the one generally selected when it is found impossible to get any guide or instrument into the bladder through th,: stricture. With the patient in the usual lithotomy position, a staff is passed down to the stricture and held there, the button-like point of the staff bearing down against the face of the narrowed tunnel. A median incision is made down to the staff, and the urethra fully divided for !, inch in front of the stricture. The edges of the wound in the urethra arc held apart by sutures or forceps, and after careful sponging a search is made for the opening of the mouth of the stricture. When this is obtained, a grooved director is passed through it into the bladder. and upon this instrument the tortuous, narrow stricture is divided for its whole extent by a narrow knife from before backwards. A large bougie is then passed down the urethra, guided into the incised part, and pushed gently into the bladder. The bladder is drained through the perineum for a few days, and afterwards regular passage of large bougies is resorted to.