662 AMPUTATION OF THE PENIS. 



(4) The ecraseur. This method and removal by galvano-cautery 

 or ligature are the most painful, but the operation only lasts a short 

 time, and an anaesthetic can be given. 



After cleansing the penis and sheath, a piece of tape is tied around 

 the end of the former to furnish a good hold. The urethra is then 

 dissected out for 1 to 1| inches and cut through, after which the 

 ecraseur is applied at the point to be divided and slowly turned. 

 There is little resistance whilst the corpora cavernosa are being 

 compressed and cut through, but towards the end of the operation 

 it becomes greater, because the tunica albuginea is then undergoing 

 division, and at this period the chain may occasionally be broken. 

 In such cases one may pass a ligature round the remainder, and 

 simply remove the end of the penis with a knife ; experience has 

 shown the operation to be perfectly successful, and healing has 

 occurred rapidly and uninterruptedly. Moller always operates in 

 this way. Not only is injury to the instrument avoided, but bleeding 

 is very slight and the wound heals rapidly. The urethra may be 

 sutured to the integument of the penis, and if sterilised catgut or 

 silk be used its edges soon become adherent, and the danger of 

 stricture is reduced to a minimum. 



Nevertheless, whatever method be employed, stricture forms the 

 most frequent and most troublesome sequel of amputation of the 

 penis. 



The insertion of a metal tube in the urethra during the first week 

 or two certainly obviates difficulty in urination consequent on in- 

 flammatory swelling, but later it operates in exactly the opposite 

 way, and it is, therefore, better to avoid such tubes. Stricture 

 usually leads to rupture of the bladder, as Cagny and others have 

 shown. 



Contraction of the urethra may be avoided by one of the 

 following methods. 



The first consists in cutting through with the bistoury or cautery 

 all the tissues of the penis except the urethra, which, after having 

 been carefully dissected out, is divided about three-quarters of an 

 inch in front of the surface of section. This kind of artificial urethral 

 tube is afterwards divided vertically and transversely, so as to form 

 four flaps, each of which is fixed to the integument of the penis by 

 means of sutures. In another method, derived from human surgery, 

 and skilfully modified by M. Guyon, a reversed V-shaped incision 

 is made immediately above the line of amputation and on the lower 

 surface of the penis, the integument being first divided, then the 

 subjacent tissues, the suspensory ligaments, and corpora cavernosa ; 



