% Jftii[i[oi[ of hospital fpctiq. nvo CASES
IMPERMEABLE STRICTURE. SHA.H, Junagadlt State Hospital. OF
By Assistant-Surgeon T. M.
Case 1.?Ranchod Devraj, Hindu male, ait. 40 years, admitted 18th August 1890. Previous history.?Gonorrhoea four years ago. Present condition.?The skin of the scrotum, perinseum, and nutes is very much indurated, and is riddled with uriuary fistulas, through
Nor.
SHAH ON IMPERMEABLE STRICTURE.
1892.]
which most of the urine escapes, only a small portion passing per urethram. Course and treatment.?On the 19th August an attempt was made to get a catheter into the bladder, but failed. Oli the 24th he was put under chloroform, the sinuses were slit up, and a
Wheelhouse's
operation to the
was
unsuccessfully
dense matting together of the tissues. He continued to pass all urine by the perineal wound up to the 17th September, when he was again anaesthetised, and a director was passed into the bladder through the perinseal wound. A catheter was next introduced through the meatus, passed along tl?e urethra, forced through the stricture, and passed along the director into the bladder, where it was retained. On the 21st September the catheter was removed, and a great portion of the urine was found to pass per urethram. On the 25th an instrument was introduced and retained for one hour. After a tedious course and several fluctuations, the catheter could be passed with ease on the 21st November, and scarcely any urine passed per periujeal wound. By the 4th December sill fistulje had closed and all urine was passed per urethram. Accordingly the patient was discharged from Hospital. Case 2.?Popat Haree, Hindu male, est. 24 years, from Ranpur, admitted on 14th March 1891, suffering from stricture and urinary fistulas. The previous history?Is one of traumatic rupture of urethra, periurethral abscess, and sinuses, the result of a fall on the perinaaum th ree years ago. Present condition.?Scrotum and perinjeum are riddled with urinary fistulas, and their tissues are indurated and distorted by inflammatory thickening, most of the urine passes through the sinuses, and only a few drops flow along the urethra. Course and treatment.?On the 15th March the patient was chloroformed, and an attempt was made to pass an instrument iuto the bladder, but failed. A staff was next introduced as far as the stricture, and an incision was made through the cartilaginous perinamm on to the staff; but the further course of the urethra could not be found, so no instrument was passed into the bladder. 26th March.?Nos. 4, 5, 6, and 7 metal catheters were passed per urethram into the bladder; and next day No. 10 was passed and retained in situ for some hours. On the 28th No. 11 was passed, but still most of the urine continued to escape through On the 30th March the the perinseal wound. scrotal sinuses were laid open, and a drainage tube was passed from the perinaeuu into the bladder. On the 2nd April a gum elastic No. 9 catheter was kept in the bladder for 24 hours, then withdrawn, cleaned, and replaced. This was repeated until the 5th. On the 6th April
attempted, owing
333
No. 11 was passed. From this time the case had a chequered coarse, but by the 1st July nearly all the urine was passed per urethram ; nevertheless it was not until the 1st October that the perin&al wound and sinuses were completely healed, and all the urine was passed per The patient could pass a No. 10 urethram. catheter on himself, and so he was discharged on the 9th October 1891. case was of gonorrhoeal second was traumatic. the Like whereas origin, most traumatic strictures it proved troublesome, and the complications were numerous.
Remarks.?The first
IMPERMEABLE STRICTURE. SHA.H, Junagadlt State Hospital. OF
By Assistant-Surgeon T. M.
Case 1.?Ranchod Devraj, Hindu male, ait. 40 years, admitted 18th August 1890. Previous history.?Gonorrhoea four years ago. Present condition.?The skin of the scrotum, perinseum, and nutes is very much indurated, and is riddled with uriuary fistulas, through
Nor.
SHAH ON IMPERMEABLE STRICTURE.
1892.]
which most of the urine escapes, only a small portion passing per urethram. Course and treatment.?On the 19th August an attempt was made to get a catheter into the bladder, but failed. Oli the 24th he was put under chloroform, the sinuses were slit up, and a
Wheelhouse's
operation to the
was
unsuccessfully
dense matting together of the tissues. He continued to pass all urine by the perineal wound up to the 17th September, when he was again anaesthetised, and a director was passed into the bladder through the perinseal wound. A catheter was next introduced through the meatus, passed along tl?e urethra, forced through the stricture, and passed along the director into the bladder, where it was retained. On the 21st September the catheter was removed, and a great portion of the urine was found to pass per urethram. On the 25th an instrument was introduced and retained for one hour. After a tedious course and several fluctuations, the catheter could be passed with ease on the 21st November, and scarcely any urine passed per periujeal wound. By the 4th December sill fistulje had closed and all urine was passed per urethram. Accordingly the patient was discharged from Hospital. Case 2.?Popat Haree, Hindu male, est. 24 years, from Ranpur, admitted on 14th March 1891, suffering from stricture and urinary fistulas. The previous history?Is one of traumatic rupture of urethra, periurethral abscess, and sinuses, the result of a fall on the perinaaum th ree years ago. Present condition.?Scrotum and perinjeum are riddled with urinary fistulas, and their tissues are indurated and distorted by inflammatory thickening, most of the urine passes through the sinuses, and only a few drops flow along the urethra. Course and treatment.?On the 15th March the patient was chloroformed, and an attempt was made to pass an instrument iuto the bladder, but failed. A staff was next introduced as far as the stricture, and an incision was made through the cartilaginous perinamm on to the staff; but the further course of the urethra could not be found, so no instrument was passed into the bladder. 26th March.?Nos. 4, 5, 6, and 7 metal catheters were passed per urethram into the bladder; and next day No. 10 was passed and retained in situ for some hours. On the 28th No. 11 was passed, but still most of the urine continued to escape through On the 30th March the the perinseal wound. scrotal sinuses were laid open, and a drainage tube was passed from the perinaeuu into the bladder. On the 2nd April a gum elastic No. 9 catheter was kept in the bladder for 24 hours, then withdrawn, cleaned, and replaced. This was repeated until the 5th. On the 6th April
attempted, owing
333
No. 11 was passed. From this time the case had a chequered coarse, but by the 1st July nearly all the urine was passed per urethram ; nevertheless it was not until the 1st October that the perin&al wound and sinuses were completely healed, and all the urine was passed per The patient could pass a No. 10 urethram. catheter on himself, and so he was discharged on the 9th October 1891. case was of gonorrhoeal second was traumatic. the Like whereas origin, most traumatic strictures it proved troublesome, and the complications were numerous.
Remarks.?The first
