Cock's perinea! operation is performed when the urethra is distended behind the stricture, no guide-staff being. employed, though the stricture is impermeable.
In the lithotomv position, the operator places his finger in the rectum upon the tip of the prostate. A sharp-pointed, thick-bladed bistour• is plunged into the middle line of the perineum. - inch in front of the anus with its back towards the bowel, so as to open the distended urethra in its membranous portion, just at the tip of the prostate. When this has been accomplished, a grooved probe is passed through the wound into the bladder, and upon this a tapering ltorget is guided. This was Cock's operation, hut usually an attempt is made to dual with the stricture at the same time as follows: After opening the bladder, a grooved probe should be passed into the wound and made to enter the stricture from behind, upon which the cicatricial tissue may be divided from behind forwards or an instrument may be inserted down the urethra and its point cut upon till it appears in the wound. When this has been achieved, a large catheter should be passed down the urethra, and guided into the bladder, and the most patient dilatations by the passage of sounds must be kept up long after the healing has been established,as such strictures are very prone to contract.
It may be only possible to effect an entrance into the bladder from behind the stricture, without being able to deal with the latter, and it is astonishing to find afterwards how easily a narrowing, which had foiled all attempts at catheterisation, can be made to yield after a few days' rest following perineal section. Hence, often the operation is divided into two stages, the dilatation or incision of the urethra being postponed for some days after the perinea] section.
Excision or Resection of the strictured portion of the urethra has been tried, but very generally with indifferent results. Wolfler found that the mucous membrane was reproduced upon a urethra from which he had excised a nodular stricture. He uses the mucous membrane obtained from the " stomach of the frog, the bladder of the rabbit, or from the tesophagus of the pigeon, which arc all easily separable from the muscular layer of the animal, and which all adhere in the human subject, and when properly placed retain their vitality." A graft taken from the mucous membrane of the lip answers equally well.
Recently Adams has demonstrated a method of restoring damaged urethra by the introduction of a tube of litier's membrane. The author lays stress on being able to supply plenty of tissue so as to be free of on the provision of suprapuhie drainage, and on the retention of a catheter wi thin the newly-formed urethra as important elements in a heterogeneous urethral graft.
The method of klectrolvsis has been practised; this may be carried out by using a current of 3 to 5 milliamperes in the following way: The negative electrode—a metal-tipped gum-elastic bougie—is passed down to the face of the stricture, against which it is held for 15, to 3o minutes, the large moist positi? e electrode being in contact with the lumbar spines. The current softens and causes decomposition of the cicatricial tissue, and permits the negative electrode to pass into the bladder, of ten in 20 minu tes, without pain.