Bulbous sound.
Divulsion was a method employed during the past generation of rupturing a stricture by forcible separation of the blades of a divided instrument, tearing it instead of neatly cutting it, thus inflicting a maximum instead of a minimum of local damage. Every divulsion thus led to a subsequent stricture formation. The procedure has been abandoned. Now by the employment of the Otis instrument, or one of its substitutes, the stricture is first found, then penetrated with the instrument, and divided to an extent easily regulated, thus permitting exact work, which is preferable to the older methods of drawing a large blade along the urethral tract.
Fig. 672
Otis’ urethrometer.
In tight strictures the operator proceeds at first with small filiform bougies made of whalebone, with which, sometimes after considerable effort with a bundle of them in the urethra, trying one after another, he may succeed in passing one and causing it to enter the bladder. The others are then withdrawn. It may now be possible to thread over the whalebone a perforated tip made for the urethrotome, and thus to slip the latter down into the depths over the fine bougie as a guide, and then to push it farther, using now more force because it must necessarily follow the urethral canal. When, however, what seems to be judicious manipulation by this method is unsuccessful the metal instrument should be withdrawn, the whalebone bougie remaining in situ, and thus serving as a guide for that which is now made necessary, namely, external urethrotomy.[72]
[72] Van Hook has recommended the following excellent expedient for the discovery of the urethral canal when apparently lost in the depths of a dense, deep stricture: He gives a dose of potassium iodide two or three hours before the operation. During the latter, and when seeking the proximal end of the urethra, he drops a little acetate of lead solution at the point where the urine is expected to appear. The formation of the bright-yellow lead iodide will mark the actual appearance of the urine and indicate its source.
Fig. 673
Otis’ dilating urethrotome.