The Treatment of Stricture of the Urethra, and Urinary Penile and Scrotal Fistulae by Electrolysis
Authors: E. Morton
Journal: BMJ (1887)

slightly hypertrophied prostate.Urethral suppositories were ordered, containingf extract of belladonna and opium.The bowels were nearly regular.On February 12th the bladder was washed out and gradually dilated.It would not tolerate more than one ounce and a half of urine.The urine was allowed to accumuilate in the bladder by stop- ping the drainage-tube with a cork ; when enough had accumulated, it was let out.During the night the water was let off tour or five times, between which the patient enjoyed a good sleep.On February 13th he had some voluntary micturition by the urethra.This was the first voluntary micturition in a year.He could hold three ounces and a half in the bladder.A No. 23 catheter was passed easily over the prostate into the bladder.The urine ran out at eight inches, but at seven and three-quarters the water stopped.On February 16th, galvano-cautery applications were made to the prostate at different places ; four flashes were given without pain.On February 18th there was improvement.The endoscope was used, and showed an almost healthy bladder.On February 20th the galvano-cautery was applied to the prostate, three prolonged flashes.The patient felt the cautery, but no pain or inconvenience therefrom.On March 2nd I had a consultation with Dr. Hutchison, who approved the treatinent and mapped out the boundaries of an enlarged prostate.The galvano-cautery was repeated.On March 9th and 13th two more galvano-cautery applications were made to prostate.The patient discontinued the treatment.He was improving steadily, and I knew of no reason for the discontinuance.On April 3rd, 1886, he went to Brooklyn Hospital, where Dr. Hut. chison performed perineal section and prostatotomy.The patient was on the operating-table about half an hour.Two hours after the operation he began to bleed quite freely, and was in great pain, and required morphine.On April 4th he passed a very restless night, having a great many spasmodic contractions of the bladder.The bladder was washed with borax solution and a large rubber tube was inserted, but it did not seem to work very well, mach of the urine coming through the old opening.April 5th.He continued to have very violent contractions, occurring every half-hour, and not controlled by morphine.Temperature 103°.The appetite was poor.On April 19th the patient was much worse, delirious during the night, face flushed, perspired very freely, pulse weak and rapid; the hyoscyamus was stopped.On April 20th he was not quite so delirious, the spasms were less frequent, but the general condition not so good.On April 24th he continued to improve, the spasms were very in- frequent and not severe.Most of the urine passed through the tube.May 24th.The tube was removed altogether, and the urine was allowed to drain away through the lower opening.The spasms wore less, and the patient felt much better.June 1st.Commenced to-day to draw the urine every two to three hours through the lower opening; the suppositories were continued.June 2nd.The above plan worked admirably, the patient retained all the urine and nothing drained away either above or below.The catheter had to oe passed every two and a half to three hours, the sup.positories were continued.June 4th.No urine had passed through the upper opening since the last plan was adopted.The urine which was drawn was very clear, and the cystitis and the spasms had entirely subsided.June 5th.The patient got up to-day for the first time, and felt first-rate in every wav.From this time the patient continued to improve steadily.He passed urine through the natural channel on June 17th without incon- venience, some escaping through the perineal incision.July 1st.The wound had entirely closed.He remained here till July 13th, when he took his discharge.For the above record from the Brooklyn Hospital I am indebted to Dr. Raynor, the house-surgeon of the hospital.August 19th, 1887.-Dr.Breswith, who assisted Dr. J. C. Hutchi- son in the operation, kindly informed me that it consisted in external median prostatotomy.The prostate was incised in the median line, but no portion of it was removed.The patient wore a large silver tube for several weeks until the upper opening left from the supra- pubic operation was closed.