Internal urethrotomy : are the benefits to be derived from it, as now advocated for the relief of stricture, commensurate with its dangers? / by Ambrose L. Ranney.

  • Ranney, Ambrose L. (Ambrose Loomis), 1848-1905.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: Internal urethrotomy : are the benefits to be derived from it, as now advocated for the relief of stricture, commensurate with its dangers? / by Ambrose L. Ranney. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    the grounds upon which internal urethrotomy lias become popular, the evils which it aims to cure, and the dangers which accompany it; and that they should also accord due weight to the opinions of men whose views are entitled to con- sideration, before accepting unconditionally a means of sup- posed relief, which is attractive from its rapidity and ease of execution, but which is not always successful, and, in some cases, not without danger. Internal urethrotomy is not a new operation. From the time of Pare, cutting instruments have been described, and modifications of these primitive appliances have, from time to time, sprung into existence, each presenting some exceedingly slight difference from its predecessor, in accordance with the taste and fancy of its advocate. The only essential point of difference between them allows, however, of their general •classification into two kinds of instruments, viz., those which divide the urethral wall freely, and those which do not injure it severely. It is not necessary to discuss here the relative merits of in- cisions from 'before backward or from behind forward, as a special aim of some instrument; nor to touch upon the fact that, by a previous stretching process before the incision is made, the certainty of division is made doubly sure. It is not the aim of this paper to discuss what is the best instrument for dividing a stricture, but to question the propriety of divi- sion, except under such circumstances as, in the general opin- ion of the best recognized authors, constitute a justifiable in- dication for the operation. Sir Henry Thompson,* in reviewing the efforts of Rey- bard, in 1855, to popularize incisions within the urethra, says: “ If the stricture be so confirmed that it will not yield to dila- tation when carefully applied, a slight notch will not facilitate its disappearance; and an extended section of the urethra, it required to effect that which other means have failed to ac- complish, permits the occurrence of internal haemorrhage and urinal infiltration, since the wound has no external outlet; a risk which we are not justified in encountering.’ * “ Brit, and For. Med.-Chir. Review,” October, 1855.