Reprinted from the New York Medical Journal for February 12, 188', 
THE METRO-URETHROTOME. 
By F. TILDEN BROWN, M. D. 
By this name I presume to call the attention of those interested in 
urethral surgery to an instrument here shown. It was devised for 
catting a stricture I could not reach with the in- 
strument I was then using. Since then—two years 
ago—I have had two others made by the same firm 
(Messrs. Stohlmann, Pfarre, & Co.), with certain 
modifications, the most important being a diminu- 
tion in the size of the bulb, and a simpler adjust- 
ment of the blade. This drawing will at once sug- 
gest the urethrometer of Dr. Weir, with the blade 
of Dr. Otis’s urethrotome. With slight alterations 
in each, the metro-urethrotome is practically a 
combination of the two. The arms spread per- 
pendicularly instead of horizontally to the plane 
of the dial. The blade is introduced through a 
slot in the graduate screw-ring, just in front of 
which it is received by a groove, along which it 
runs to the upper semi-bulb, where it sheaths it- 
self. To raise and hold the blade in position while 
cutting is effected by turning the graduate screw- 
ring which bears against a shoulder .at the blade 
hilt, thus drawing up the blade, the back of which 
rides on an incline in the upper semi-bulb. Spread- 
ing or closing the bulb does not, of course, influ- 
ence the elevation of the blade, except relatively 
to the lower semi-bulb. In this respect the instru- 
ment offers an opportunity for fine and accurate 
adjustment unattainable in any I know of. Here 
one complete turn of the screw-ring unsheaths the 
blade to a certain height; the dial records the bulb 
spread, and any resistance then felt in drawing the 
instrument forward is referable only to the limited 
area in apposition with the semi-bulbs, the depth 
of which is known by noting the inch- or half-inch 
mark on the staff at the meatus. 
As can be seen, the instrument offers facilities 
for cutting the urethra up to any desired caliber 
without interfering with a meatus which admits 
only a 15 French. In this respect I believe it to 
be unique. With it I had hoped to satisfy myself 
upon the much-mooted question of the neces- 
sity of enlarging the meatus to the size of the urethra where cut 
at the strictured portion, but the want of a specially made dilating 
sound for subsequent treatment has thus far deterred me from mak- 
ing the test. Until we have some such form of small-necked dilat- 
ing sound—one which will dilate, at the same time, about four inches 
and a half of the urethra symmetrically without stretching or affecting 
the meatus—until then, the necessity of this nearly uniform caliber is 
evident; for a meatus one or two sizes smaller than the urethra within 
renders ineffectual the presence of the largest sound permissible by 
such a meatus. As already stated, the instrument was devised for a 
special case, where a deep organic stricture of gonorrhoeal origin 
existed. I had previously cut two anterior strictures, and hoped the 
disappearance of this deeper one would prove its spasmodic origin. 
Disappointed, however, I attempted two weeks later to operate with Dr. 
Otis’s straight urethrotome, but failed to reach it because of the sub- 
pubic curve preventing sufficient insertion. I thought of resorting to a 
Maisonneuve or a Civiale, but the size of blade in each and the location 
of the stricture deterred me. The Weir urethrometer was modified for 
the purpose, and the stricture cut without annoying haemorrhage or 
complication of any kind. Although this has been the only deep strict- 
ure of the sort I have met with in two years, I have still had occasion to 
use the instrument or its modifications in a large proportion of opera- 
tions in the penile urethra. 
In cases presenting an almost continuous two inches or more of 
dense stricture tissue, occupying any part of the anterior four inches of 
the urethra, and where the caliber will permit its use, the great advan- 
tages of Dr. Otis’s instrument are too manifest to require comment. 
There are few instruments of surgical importance which so perfectly 
fulfill their mission. In lesser operations, however, where one or sev- 
eral, more or less distinct, annular strictures exist, whether deep or 
anterior, I believe the metro-urethrotome will be a safer and more accu- 
rate instrument. The economy of time in handling is also some ad- 
vantage, for with it a single insertion may serve to diagnosticate and 
locate a stricture, to cut it, and to prove the satisfactory completion of 
the operation. An almost universal acquaintance with the urethrome- 
ters of Otis and Weir renders it needless to describe the handling of the 
metro-urethrotome as a diagnostic instrument. As to its management as 
a cutting agent a few words will suffice. Say at three inches a stricture 
is found permitting 27 French, the urethra anterior and posterior to it 
expanding to 32, representing the normal in this particular case. The 
closed instrument with sheathed blade is passed to the proximal side of 
the stricture—i. e., about three inches and a half. The semi-bulbs are 
spread to 27, and brought a little forward until they are at the verge of 
the contracted zone. Now, by two complete turns of the screw-ring, 
the blade is unsheathed to its fullest extent and presents against the 
center of the urethral roof. By moderate and guarded force the whole 
instrument is drawn forward. As the stricture is severed a characteristic 
sensation is conveyed to the hand. Sheath the lessen the bulb 
spread, and sink to the starting point, enlarge to 32, and draw forward; 
perhaps at the point of stricture the spread must be relaxed to 31; if 
so, unsheath the blade slightly by a partial turn of the screw-ring and 
repeat as before. I think it better to go over the ground in this way, 
two or three times if necessary, rather than risk injury by undue cut- 
ting or stretching in attempting instant completion. Although it has 
been my practice to repeat the incision along the urethral roof, it may 
be found advantageous in some cases to sever the opposite face or the 
side wall of the stricture when a second section is found necessary. I 
have reason to believe that severing a stricture is much less painful 
than putting it on the stretch; for, in using this instrument without 
even cocaine anaesthesia, patients have assured me that the cutting 
was not nearly so annoying as the pain previously caused by passing 
a sound. The last changes in this instrument affect the lever which 
spreads the bulb; the point now impinges upon almost the apex of the 
upper semi-bulb, thus affording additional stiffness, and a long, narrow 
fenestra in the lever permits the blade to sheath through it and thus 
utilize the hollow space in the lower semi-bulb; in this way a reduction 
in the size of the bulb has been obtained. The drawing shows the 
blade partly unsheathed in the upper semi-bulb. 
40 East Thirty-first Street.