(3) The plastibell method for infants is done in a somewhat different way. A
dorsal slit is made, adhesions freed, and the bell placed over the glans inside the
foreskin. A suture is tied lightly around the bell, compressing the foreskin into the
groove. The free skin is trimmed and the bell handle is broken off.
3-40. URETHRAL MEATOTOMY
a. General. This involves incisional enlargement of the external urethral
meatus. The procedure is done to relieve stenosis or stricture.
b. Patient Preparation. For the male, a supine position is generally used, and
the penis is elevated on a small folded sheet. For the female, the lithotomy position is
used. Either general or topical anesthesia may be used. Cocaine 5 percent is used for
the meatus and 2 percent procaine with bulb syringe is used for instillation into the
c. Operative Procedure. A straight hemostat is applied to the ventral surface
of the meatus. An incision is made along the frenulum to enlarge the opening and
overcome the stricture. Bleeding vessels are clamped and ligated with fine plain
surgical gut sutures. The mucosal layer is sutured up to the skin with fine plain gut
sutures. A dressing of petrolatum gauze may be applied.
3-41. EXCISION OF URETHRAL CARUNCLE
a. General. This procedure involves the removal of papillary or sessile tumors
of the urethra. It is done to rectify an inflammatory prolapse from the lower lip of the
female urinary meatus.
b. Operative Procedure for the Removal of Papillary Growth. The growth is
exposed, clamped at its base with curved hemostats, and excised. A urethral indwelling
catheter is inserted into the bladder. The wound is closed.
c. Operative Procedure for Removal of Sessile Growth. A circular skin
incision is made around the meatus and carried through the submucosal layer. The
urethra is freed from the caruncle, the meatus is dissected back to the healthy tissue,
and the diseased portion of the urethra is excised. The mucocutaneous junction is
approximated with fine chromic gut sutures. An indwelling urethral catheter is
introduced and is kept in the bladder for at least 5 days.
3-42. URETHRAL DILATATION AND INTERNAL URETHROTOMY
a. General. This procedure involves the gradual dilatation and removal of a
urethral stricture to provide for adequate urinary drainage of the kidney.
b. Operative Procedure for Gradual Dilatation. The urethra is lubricated and
anesthetized. In the male patient, the penis is clamped and the urethra anesthetized. A