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New device for overcoming urethral stricture in female
NEW DEVICE FOR OVERCOMING URETHRAL STRICTURE IN FEMALE A.
J. D.
MARAZITA,
M.D
New York, New York
T
HE femaIe urethra is I $4 to 2 inches in length, pierces the urogenital diaphragm and extends from the base of the bladder
in these cases vaginitis may exist. Study of the genitourinary tract is necessary to eliminate infection in the kidneys and ureters and, lookB-2
FIG. I. A, rubber end catheter cut; B, heavy bIack silk sutured into catheter; C, catheter opening; D, thin uterine dressing forceps; E, mosquito ctamp.
to the externa1 urethra1 orifice. Its course is sIightIy curved and runs roughIy paraIIe1 to the vagina1 axis. The urethra has three coats: (I) a mucous coat, (2) submucous and (3) muscuIar coat. The mucous coat consists of transitiona1 epithelium, continuous with the bIadder. The muscuIar coat consists of an outer circuIar and an inner Iongitudinal Iayer of muscuIar fibers. The circuIar fibers are distinctly deveIoped at the neck of the bIadder and there form a distinct sphincter. Just inside the externa1 meatus Iie skenes, gIands and ducts. There is a difference of opinion concerning the frequency of urethral stricture. Some authorities believe urethra1 stricture is not too common and almost rare, whiIe others like W. E. Stevens, found 328 urethra1 strictures in 425 patients with urinary disturbances. The fact that only a very small portion of the urethra is seen, and occasionaIIy not at aI1, is one reason why this important cana is frequently overIooked in urinary disturbances. There is no doubt that urethritis preexists and coexists in urethral stricture, except in the congenital cases seen in infants and chiIdren in which anomalies may exist. Even
ing stiI1 further, eIiminating other sources of infection in the mouth, sinuses, uterus and and aIso caIcuIi in the especially cervix, kidneys or bIadder. The Iatter are brought to light through retrograde pyeIography under anesthesia. The important symptoms in order of freof urination, pain, quency are: frequency burning and urgency. DESCRIPTION OF DEVICE
This simpIe device for overcoming urethra1 stricture consists of the front 245 inches of a No. 14 French rubber catheter, which has two sutures of medium weight bIack siIk taken at the end of the catheter; these sutures are tied and are placed in order to prevent the catheter from sIipping into the bIadder prior to diIatation. A smaI1 mosquito cIamp is then (Fig. I.) placed on one end of the suture. A 2 per cent soIution of butyn@ or I per cent novocaina is instiIIed into the urethra1 cana and left in situ for five to ten minutes. FoIIowing this the sterile lubricated catheter is inserted, and a mosquito clamp pIaced on one of the ends of the black silk sutures. A thin
214
American
Journal of Surgery
PracticaI
Surgical
uterine dressing forceps Iubricated with sterile lubricating jelly is then inserted through the catheter end and diIatation performed in the various quadrants of the cIock. The advantages of this simple method are the foIlowing: No meta touches the mucous membrane, its ease of use in the offrce and the fact that the procedure is almost painless. Dilatation should be performed at periodic intervals.
Suggestions
215 REFERENCES
EVERETT, H. S. Urethral stricture. Text Book of Gynecofogy, Obstetrics and Urology, pp. IOZ-I IQ. HUNNER, G. L. Chronic urethritis. J. A. M. A., 96:
937.'9'1. W. E. Stricture of the urethra in women. Calijornia Med., 20: 51, 1922. STEVENS, W. E. Diseases of the female urethra. C&ifornia P west. Med., 26: 471,1927. CYCONOR, V. J. Diseases of the urethra in the female. Am. J. Surg., 38: 148, 1937. STEVENS,
FROM the point of view of the average genera1 surgeon, there are a certain number of objections to the operation of total gastrectomy. Not only is the technic more diffIcuIt and the mortaIity higher, but also no defmite proof exists that a greater number of patients can be cured by this radical procedure as compared with the five-year results after subtotal gastrectomy. Finally, total gastrectomy causes interference with proper fat and protein assimilation in many patients so that they fail to regain their preoperative weight and nutritional status, aIthough a high fat and Iow carbohydrate diet, taken frequentIy and in small quantities, wiI1 probabIy be helpful in many of these latter instances. (Richard A. Leonardo, M.D.)
August,
1953
J. D.
MARAZITA,
M.D
New York, New York
T
HE femaIe urethra is I $4 to 2 inches in length, pierces the urogenital diaphragm and extends from the base of the bladder
in these cases vaginitis may exist. Study of the genitourinary tract is necessary to eliminate infection in the kidneys and ureters and, lookB-2
FIG. I. A, rubber end catheter cut; B, heavy bIack silk sutured into catheter; C, catheter opening; D, thin uterine dressing forceps; E, mosquito ctamp.
to the externa1 urethra1 orifice. Its course is sIightIy curved and runs roughIy paraIIe1 to the vagina1 axis. The urethra has three coats: (I) a mucous coat, (2) submucous and (3) muscuIar coat. The mucous coat consists of transitiona1 epithelium, continuous with the bIadder. The muscuIar coat consists of an outer circuIar and an inner Iongitudinal Iayer of muscuIar fibers. The circuIar fibers are distinctly deveIoped at the neck of the bIadder and there form a distinct sphincter. Just inside the externa1 meatus Iie skenes, gIands and ducts. There is a difference of opinion concerning the frequency of urethral stricture. Some authorities believe urethra1 stricture is not too common and almost rare, whiIe others like W. E. Stevens, found 328 urethra1 strictures in 425 patients with urinary disturbances. The fact that only a very small portion of the urethra is seen, and occasionaIIy not at aI1, is one reason why this important cana is frequently overIooked in urinary disturbances. There is no doubt that urethritis preexists and coexists in urethral stricture, except in the congenital cases seen in infants and chiIdren in which anomalies may exist. Even
ing stiI1 further, eIiminating other sources of infection in the mouth, sinuses, uterus and and aIso caIcuIi in the especially cervix, kidneys or bIadder. The Iatter are brought to light through retrograde pyeIography under anesthesia. The important symptoms in order of freof urination, pain, quency are: frequency burning and urgency. DESCRIPTION OF DEVICE
This simpIe device for overcoming urethra1 stricture consists of the front 245 inches of a No. 14 French rubber catheter, which has two sutures of medium weight bIack siIk taken at the end of the catheter; these sutures are tied and are placed in order to prevent the catheter from sIipping into the bIadder prior to diIatation. A smaI1 mosquito cIamp is then (Fig. I.) placed on one end of the suture. A 2 per cent soIution of butyn@ or I per cent novocaina is instiIIed into the urethra1 cana and left in situ for five to ten minutes. FoIIowing this the sterile lubricated catheter is inserted, and a mosquito clamp pIaced on one of the ends of the black silk sutures. A thin
214
American
Journal of Surgery
PracticaI
Surgical
uterine dressing forceps Iubricated with sterile lubricating jelly is then inserted through the catheter end and diIatation performed in the various quadrants of the cIock. The advantages of this simple method are the foIlowing: No meta touches the mucous membrane, its ease of use in the offrce and the fact that the procedure is almost painless. Dilatation should be performed at periodic intervals.
Suggestions
215 REFERENCES
EVERETT, H. S. Urethral stricture. Text Book of Gynecofogy, Obstetrics and Urology, pp. IOZ-I IQ. HUNNER, G. L. Chronic urethritis. J. A. M. A., 96:
937.'9'1. W. E. Stricture of the urethra in women. Calijornia Med., 20: 51, 1922. STEVENS, W. E. Diseases of the female urethra. C&ifornia P west. Med., 26: 471,1927. CYCONOR, V. J. Diseases of the urethra in the female. Am. J. Surg., 38: 148, 1937. STEVENS,
FROM the point of view of the average genera1 surgeon, there are a certain number of objections to the operation of total gastrectomy. Not only is the technic more diffIcuIt and the mortaIity higher, but also no defmite proof exists that a greater number of patients can be cured by this radical procedure as compared with the five-year results after subtotal gastrectomy. Finally, total gastrectomy causes interference with proper fat and protein assimilation in many patients so that they fail to regain their preoperative weight and nutritional status, aIthough a high fat and Iow carbohydrate diet, taken frequentIy and in small quantities, wiI1 probabIy be helpful in many of these latter instances. (Richard A. Leonardo, M.D.)
August,
1953