The principles and practice of modern surgeryPark, Roswell
Science
The principles and practice of modern surgery
Park, Roswell
Surgery
=Complications.=--Complications may occur along any portion of the
genito-urinary tract. These will be considered in their anatomical
order.
=Balanitis.=--Balanitis signifies an inflammation of the mucosa
covering the glans. When the mucous surface of the prepuce is also
involved, as it usually is when the orifice is contracted, then the
condition is known as _balanoposthitis_. In the absence of ordinary
cleanliness of the parts this may go on to erosion or extensive
ulceration. It is sometimes complicated with chancroid or chancre. When
such a condition exists, and the glans cannot be sufficiently exposed
for purposes of cleanliness, the dorsum of the prepuce should be slit
up sufficiently to permit of complete exposure, while in some cases the
edema and the infiltration will be such as to justify circumcision.
When needed these operations should be practised even if raw surfaces
are thereby left exposed to infection. Such possibility may be usually
obviated by cauterizing a fresh surface, as soon as exposed, with pure
carbolic acid or one of the stronger caustics, or operation may be made
with the thermocautery.
=Folliculitis.=--Folliculitis implies the extension of the infection
to the follicles and lacunæ which abound within the urethral canal. As
long as their orifices do not become occluded they easily discharge
their contents into the urethra, but when so swollen as to become
occluded they lead to the formation of abscesses, which, beginning in a
minute way, may sometimes give relatively extensive disturbance. These
discharge internally; sometimes they so present that they may be opened
externally, as they should be under these circumstances. They form a
communication between the urethra and the exterior, and in this manner
the majority of the ordinary urinary fistulæ are produced. These often
occur in the perineum, but sometimes even in the pendulous portion.
=Peri-urethritis.=--Inflammation frequently extends beyond the
anatomical confines of the urethra, and produces a degree of
infiltration which is often well marked and disastrous. The site of
such a lesion is marked by a nodule, more or less tender, which may
subsequently break down into an abscess. The pus from these abscesses
will usually escape into the urethra. Sometimes it burrows into
the tissues of the corpus spongiosum, or travels even farther, and
produces locally extensive destruction of tissue, with its possibility
of urinary infiltration as a sequel, and all the septic disturbances
which can be imagined as resulting therefrom. Thus fistulas often
follow abscess formation, and these may be succeeded by phlebitis of
the peri-urethral and prostatic plexuses, extensive destruction or
multiple abscesses, or even gangrene and pyemia. Peri-urethritis is the
essential factor in the production of strictures of the urethra, which
constitute an exceedingly common condition.
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