AMPUTATION OF THE PENIS 387 



the seat of amputation and allowing it to hang pendulent 

 from the sheath while healing of the stump proceeds. The 

 cause of stricture in almost every case lies in the marked 

 elasticity of the urethral tube which, if cut off at or even near 

 the stump, contracts behind the seat of amputation and al- 

 lows the cicatrix to form over its end. By leaving a long por- 

 tion to protrude, the shrinking up, sloughing off and healing 

 of the urethra keeps pace with the healing of the stump, so 

 that when the latter has entirely cicatrized the former is still 

 protruding far enough to prevent its incarceration within the 

 stump cicatrix. 



Stricture of the urethra supervening amputations occurs 

 at about the second week of convalescence, although in some 

 cases where certain precautions to prevent were taken, it 

 may be delayed for one month to six weeks. The patient 

 will be noticed to urinate with some difficulty. The stream 

 will become smaller and smaller until only drops are voided 

 during the almost constant efforts to empty the fast-filling 

 bladder. Later the bladder will become enormously dis- 

 tended, and by pressure upon the rectum the symptom 

 changes into an attempt to defecate ; the urinary signs almost 

 entirely disappear. Upon examination of the stump the ure- 

 thra, just behind the cicatrix, will be found fluctuant from 

 distention with urine, and urine may be flowing drop by 

 drop from the sheath. 



The treatment, in order to be successful, should begin 

 early, for after the bladder has been severely stretched for 

 days fatal results may follow its successful evacuation. The 

 first step to take in attempting to make a new permanent 

 meatus is that of emptying the bladder with the trocar and 

 canula passed into it through the rectum. (See cystocentesis 

 page 68.) This precaution is necessitated by the danger of 

 casting an animal whose bladder is so enormously full, and 

 in order to prevent fatal shock where the bladder has been 

 full for some days this rectal evacuation must be done with 

 a canula of small caliber. When the bladder has been thus 

 emptied the patient is cast, the penis drawn out from the 

 sheath and an incision made into the end of the urethra. To 

 prevent recurrence of. the stricture, which is often impos- 

 sible, the incision should be not less then one inch long, and 

 a soft rubber tube four inches long should be inserted into it 

 and retained by sewing the end to the surrouding skin. After 

 ten days the tube is removed, and if at the end of ten days 

 more the stream is becoming gradually smaller and smaller, 

 indicating recurrence, it is reinserted for another similar 

 period, 



