I  believe  we  will  have  better  results  by  treating  each  case  on  its
individual  merits.  The  stricture  which  is  comparatively  light  and  does
not  involve  the  whole  corpus  spongiosum  may  be  completely  divided,
as  shown  by  the  entire  absence  of  resistance  when  the  blades  of  the
urethrotome  are  separated,  after  cutting  the  stricture.
In  the  ease  of  a  heavy  stricture  which  involves  all  the  corpus
spongiosum  we  cannot  divide  the  whole  thickness  of  the  stricture,  but
must  content  ourselves  with  cutting  it  through  partially,  and  trust  to
keeping  the  channel  open  by  passing  sounds  frequently  for  the  rest  of
the  patient's  life.
After  the  stricture  has  been  cut  to  the  extent  which  we  desire
and  the  urethrotome  has  been  withdrawn,  a  bulbous  bougie,  No.  30
or  32  French,  is  introduced  into  the  canal,  to  make  sure  that  all
bands  are  completely  divided.
j^20  STRICTURE  OF  THE  URETHRA.
After-treatment. — The  patient  should  be  kept  in  bed  and  on  light
diet  and  directed  to  drink  freely  of  water  and  milk  to  dilute  the  urine.
In  order  to  keep  the  cut  surfaces  from  growing  together,  a
straight  sound  can  be  passed,  every  day  for  the  first  week  and  sub-
sequently every  second  da}^  and,  after  a  month,  once  a  week.  Later
the  passage  of  the  sound  need  only  take  place  once  a  month;  but
there  is  always  danger  of  recontradion  unless  a  sound  is  passed  at
intervals.
Dangers  of  Internal  Urethrotomy. — Mortality,  2  to  5  per  cent.
(a)  Haemorrhage.
(h)  Infiltration  of  urine  through  wound  into  tissues,  producing
abscesses  and  septicaemia.
(c)  Urinary  fever.  It  is  especially  important  to  see  that  the  kid-
neys are  healthy  before  doing  an  internal  urethrotomy.
(d)  Deformities  of  the  penis  subsequently.
