The after-treatment resembles in all respects that prescribed after operation for laceration through the sphincter ani. The sutures should be removed in two weeks. CHAPTER XXXVII. DISEASES OF THE URETHRA AND BLADDER. Before considering in detail the diseases of the urethra and bladder, it will be necessary to describe the modern methods of examining these structures. The examination of the urethra and bladder has been very much facilitated by the methods and instruments that have been popularized in this country by Kelly. The following apparatus is required: a female catheter; a urethral calibrator; a series of specula with obturators; a head-mirror and light or an electric headlight; long, delicate toothed forceps (Fig. 184); an inclined plane or several hard pillows for elevating the pelvis; small balls of absorbent cotton about the size of a pea, or strips of absorbent gauze cut 1 inch in width and about 10 inches long, for drying out the bladder. [Illustration: FIG. 184.--Mouse-tooth forceps for bladder.] [Illustration: FIG. 185.--Urethral dilator: short lines indicate diameter in millimeters.] The urethral calibrator or dilator (Fig. 185) is a conical metal instrument with a maximum diameter of twenty millimeters. The diameters in millimeters of the various portions are indicated by numbers upon the instrument. The urethral calibrator is useful for dilating the external meatus to a degree sufficient to admit the necessary speculum. The external meatus is, as a rule, the only portion of the urethra that requires dilatation. Any instrument that will pass through the meatus will pass through the rest of the canal. [Illustration: FIG. 186.--Kelly’s cystoscope or vesical speculum.] The speculum (Fig. 186) is a cylindrical metal tube fitted with a handle on which is the number indicating the size of the instrument. There are a number of specula, varying in diameter from 5 to 20 millimeters. Each speculum is fitted with an obturator. The most useful specula are those ranging from 8 to 12 millimeters in diameter. The urethra may readily be dilated up to 12 millimeters, with little if any, external laceration. Dilatation sufficient to admit the largest instrument (20 millimeters) is always accompanied by considerable laceration of the urethral opening. Dilatation of the urethra should never be practised beyond this degree, on account of the danger of subsequent incontinence of urine. An anesthetic is usually required for the examination, unless the woman be capable of enduring considerable pain, or has become accustomed to the procedure from previous experience. Local anesthesia of the urethra with cocaine (gr. x to ℥j) is often sufficient.