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The genito-urinary surgeon or the general practitioner of medicine is confronted with no graver condition in the routine of practice than the fortunately rare impervious urethral stricture, as, with the patient anesthetized and the structures covering the urethral site divided, with or without a Wheelhouse staff or other guide, down to the stricture, he finds it simply impossible to locate the proximal lumen, or anything resembling the mucous membrane of the urethra.
It is a well-known fact that the best genito-urinary surgeons are frequently baffled by this condition, and utterly fail to enter the bladder by the ordinary methods of urethrotomy, with or without a guide. The statement, "with a guide," refers to a catheter or staff introduced via the meatus and extending only down to the stricture, the usual meaning, "with a guide," obviously not being intended, since, of course, no difficulty could ensue if even the smallest filiform
PENN GW. URETHROTOMY BY THE COMBINED USE OF AN ANTERIOR AND POSTERIOR SOUND USED AS GUIDESTHE LATTER BY MEANS OF PREVESICAL PUNCTURE WITH A CURVED TROCAR CANNULA DESIGNED FOR THE PURPOSE.. JAMA. 1904;XLII(2):97-99. doi:10.1001/jama.1904.92490470025001f