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Genito Urinary Organs



Beck's Operation for Hypospadias. Beck's method was put to test in seven children between the ages of one and nine years. In none of the instances was the distance of the urethral orifice from the glans penis more than one and one-half centimetres. The glans penis was split and not tunnelled with the trocar, since the already flat tened glans penis did not lend itself to the latter procedure, though it possesses some marked advantages. All haemorrhage could be controlled by pressure. The dissection to mobilize the urethra was not difficult, nor ever inflicted any injury. The average length of the urethra prepared was two centimetres. Towards the base of the urethra, where the relation, with the corpus cavernosum, is very intimate, hmmorrhage is freer, but controllable by pressure. Among the disturbances encountered are early cutting through of the sutures, resulting in retraction of the urethra to its original site. In small infants, it is im possible to prevent soiling and disturbance of the dressing. Erections often caused cutting of ligatures. In one instance the formation of a large hwmatoma caused such gaping of the wound that Thiersch's method was resorted to. Three times successful result was obtained with a single operation, and in two others only after a repetition of the operation. These second operations were easier and pleasanter than the first because the new connective tissue was easier to handle and fix in a new place. A catheter en-demeure was found of benefit during the first three days. The failures recorded occurred at a time when no catheter was em ployed. Though no necrosis was met, yet twice at the inferior angle a small fistula persisted, caused by traction of the urethral wall embedded at its new site. The treatment of the fistulze was rebellious. Notwithstanding these few slight drawbacks, it is the author's opinion that this operation merits a liberal recom mendation for its widespread application. Beitriige zur klinischen Chirurgie, Band xxix, Heft 1.

Remote Results of the Operative Treatment of Pros tatic Hypertrophy. The author reviews the re suits of various methods of operating on the hypertrophied pros tate. Cystostomy should be a last resort, and is purely a means of palliation. The results from castration are unequal. Out of sixty-eight cases observed from eight to four years after opera tion, only four presented distinct atrophy of the gland, forty-one showed some diminution, while in twenty-three the gland was either unchanged or had enlarged.

Resection of the vas deferens is inefficient ; in favorable cases it is followed by a slight improvement, but this is only tem porary. The most favorable results apparently are those obtained from Bottini's operation, but not infrequently recurrence is noted after four to five months. The mortality of this operation is 5 per cent. The best results may be expected in cases of localized obstruction.

Suprapubic prostatectomy has a mortality of from 5 to 15 per cent., and is naturally only suitable for cases of isolated hyper trophy of the middle lobes. Out of 333 collected cases, the hyper trophy was limited to the middle lobe in 121, in 156 both middle and lateral lobes were involved, while in fifty-six the trouble was in the lateral lobes alone. After eliminating the operative deaths and cases insufficiently followed, 242 cases remain, of which 140 were cured or improved, and in 102 the result was negative.

Perineal prostatectomy had not been practised sufficiently long to permit of a review of the ultimate result. La Presse Medicale, i9oo, No. 8.

operation, results, urethra, glans, lobes and result