Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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micturate, it will be foundthat a catheter will not pass into the bladder, or on being apparently intro-duced (really passing into the prevesical space) the product is blood-stainedurine. It may not be easy to distinguish such cases from those of extra-peritoneal rupture of the bladder, but in the condition under discussionthe bladder is likely to be distended and palpable above the pubes as arounded tumour, in addition to the irregular swelling at its sides due toextravasation. Injecting saline solution per urethram and measuring theamount returned may help, and the next step is to explore the bladder bysuprapubic incision, when there will be found a considerable extravasationin the prevesical tissues, and if any doubt remains the bladder may beopened outside the peritoneum, when its interior will be found intact;this will do no harm, as suprapubic drainage will be needed later (see p. 562). (2) In the more common perineal form of rupture the signs are OPERATIONS FOR HYPOSPADIAS 607
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Tic 205. Operation for perineal hypospadias. A, Hypospadias before operation.!,. Penia diaeeoted up,.leaving raw urea beneath itj dottedline shows the perinealflap. C, A flap oi prepuce and dorsal skin of the penia to join the anterior urethraby inserting through the glana in the line a. D, Perineal Map dissected up to formthe posterior urethra, raturedin place; the preputial flap is also seen and the aporturein the (.dans through which it is pulled. E, Preputial flap in place is being sewn tothe perineal flap or tube, while the skin of penis and scrotum is being sutured overall; 0, preputial portion ; b, perineal portion of tho now urethra. 608 A TEXTBOOK OF SURGERY

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