John L. Emmett

Difficulties in urethral catheterization

Abstract Urethral catheterization of the male patient may at times become a very difficult procedure, and if not skillfully done, it may result in serious consequences to the patient. The anatomy of the urethra should be carefully borne in mind, as false passages are most commonly made in the floor of the bulbous urethra, due to the laxity of the floor of the bulbous urethra and its position in relation to the external sphincter and the fixed prostatic urethra. It is always well to attempt to hug the roof of the urethra with the urethral instrument. Relaxation of the patient is most important and is best secured by gentleness of manipulation. If necessary, morphine should be employed. A well-selected group of the various types of catheters and a knowledge of when and how to use them will nearly always solve the problem of difficult catheterization. When a catheter is to be left in place for any length of time it should be properly adjusted and fastened in such a way that its position may be readily changed if it slips out of adjustment. A sterile connection to a sterile closed receptacle will reduce ascending urinary infection to a minimum.

Changing conceptions of indications for surgical relief of prostatic obstruction

HEN a patient seeks reIief from definite symptoms of prostatic obstruction, such as a smaI1, sIow, interrupted stream that is diffIcuIt to initiate, termina1 dribbling, frequency, urgency and nocturia, the finding of considerabIe residua1 urine on examination aIways gives a physician a sense of security in his diagnosis and in his advice that surgical reIief of the obstruction is imperative. The presence of prostatic enrargement with marked symptoms of obstruction but with IittIe or no residua1 urine, however, presents a somewhat different problem. In such a case the patient may be as uncomfortabIe and incapacitated as is the patient with simiIar symptoms who is carrying a Iarge amount of residua1 urine. The difference Iies in the fact that the patient with a large amount of residua1 urine or one suffering from compIete urinary retention is in fairIy immediate danger of hl I f b ‘s i e ecause of the inevitabIe onset of such serious sequela as urinary infection and renaI insuffIciency. In Iight of this serious prognosis, surgica1 relief of the obstruction must be advised no matter what the risk of the operation might be. In a11 eras the conscientious physician has weighed the risk of disease against the risk of treatment. As a resuIt, when tota prostatectomy was the soIe method of surgica1 relief, many patients with prostatic obstruction were destined to years of suffering and to varying degrees of disabiIity because they were abIe to empty their bIadders suffrcientIy to avoid the possibiIity of an early renaI death unIess reIieved of the obstruction. It is quite natura1 that this shouId have been the case because MINNESOTA