Bougies

BOUGIES (from French bougie-candle), instruments intended for the dilation of certain types of examination and treatment of the excretory ducts of tubular form of some excretory organs of the human body. The use of B. is known from deep antiquity; the treatment of urethral stricture is encountered among savage nations, which use as B. thin smooth twigs of plants. During the excavations of Pompeii, metal (bronze) B. for the urethra were found, very similar to modern ones. Wax candles of different calibers were used in olden times as B. Most often B. are applied for the examination and treatment of stricture of the urethra. B. are made of metal and so-called soft ones. -Metal B. are made of tin, nickel silver and steel. Tin ones have almost gone out of use, since the possibility of changing their curvature, which was highly valued by doctors of the past century, turned out not always to be necessary, and when boiled they easily lose their polish and then are difficult to introduce. Modern B., nickel silver and steel, are made with a mirror polish and are protected from oxidation and rust by careful nickel plating. The shape, curvature, weight of the handle and length are very different; different types received names by the surnames of the authors of the models. Thickness is measured by numbers: the basis is the size of the diameter of the section, expressed in mm for scales such as the French (Charrier) and German (Benecke), and English. The first has 30 numbers, distinguished by a gradual increase in diameter by ¹/₃ mm. The thickest B. has a diameter of 1 cm. The Benecke scale contains 60 numbers, distinguished by a diameter of 7/8 mm, i.e., the gradual thickening proceeds at half the previous size for each subsequent number (with the same maximum diameter of 1 cm). The English scale has 16 numbers, distinguished by ¹/₁ mm, with a maximum B. diameter of 9 mm. It is less common. Metal B. are short and straight for the anterior urethra (Dichter, see Fig. 1) and long to penetrate through the entire urethra into the bladder. They must have at their end, called the beak, a curvature corresponding to the curvature of the urethra, for the convenience and safety of introduction. The handle, the so-called "pavilion", is made either small and light or more massive and heavy, so that the introduced B. is held by the weight of the pavilion and is not pushed back (Nitze). The most common metal B. are the Guyon models, the curvature of which resembles an open question mark (see Fig. 2). Next in use are B. with the curvature of Ulzmann, with a bluntly bent end, and Roser, distinguished by the fact that the end is thickened and has a spoon-like shape (see Fig. 3). All these B. are made and sold usually in sets in boxes, starting from thin numbers, approximately Nos. 10-12 of the Charrier scale, to the maximum. The thinnest numbers would easily bend or prove (due to thinness and sharpness) dangerous upon introduction, as they could easily puncture the wall of the mucous membrane and make a false passage; therefore the thinnest numbers are made with a screw-on soft conductor (bougie a conductrice) of the Lefort type, made of silk braiding impregnated with a viscous mass. The conductor itself is sufficiently elastic and flexible to be introduced separately, after which a metal bougie is screwed onto it. This connection is made by a special metal short sheath, into which the blunt and thicker end of the soft conductor is fixed (pressed in). When introducing a metal B., the soft conductor goes into the bladder and coils in it in rings, so as not to hinder the introduction of the metal instrument to the end, which follows it. The danger of making a false passage with this is completely eliminated, but since the fixation d (

(1 12 13 1-urethral bougie for the anterior urethra; 2-Huyon's metal bougie; 3-Rozer's bougie; 4-elastic cylindrical bougie; 5-the same with a spoon-shaped end; 6-elastic thread-like bougie; 7-thread-like curved bougie; 8-headed bougie with shot; 9-headed bougie; 10-15-metallic bougies for the lacrimal-nasal canal. A soft B. cannot be made perfectly reliably in a sheath, and a soft bougie easily breaks and weakens at the sheath; before use one must always test whether the conductor holds firmly in the sheath, so that the thread-like end does not remain in the bladder after the extraction of the metallic part. Elastic soft B. first appeared in the middle of the 19th century in France. Now they are manufactured in other countries as well. They are made so that the basis is a fabric of silk or hemp, woven on corresponding metal templates in the form of a tube. This basis is impregnated and covered with several layers of special resinous, oil varnishes so that a perfectly smooth, mirror-like and sufficiently thick mass is obtained. The quality of the instrument depends not only on the material of the fabric (silk ones are the most durable), but especially on the quality of the varnish itself and the evenness of the product. The instrument must be brilliantly smooth and even, and the varnish coating must be so elastic that it does not tear or give cracks and folds when bent. The varnish must be resistant to water, not become soggy, and, if possible, withstand the corresponding sterilization procedures. These B. are made cylindrical (see figure 4), with a uniform end (see figure 5) or conical, thread-like at the end (see figure 6). Thread-like B. with a short, bent at an angle of 25 to 40°, beak (see figure 7), so-called spear-shaped, are especially useful for strictures. Among elastic bougies one must also note Huyon's headed B. (a boulle; see figure 9), serving for the examination of stenoses and determining the length of the stenosed place, before and after which the headed dilator at the end of the instrument moves freely, while along the stenosed part it moves with friction. To give elastic B. greater elasticity, their cavity was previously tightly¹ filled with shot (see figure 8) or lead filings and hermetically sealed, but now especially strong and elastic B. are made so that several thin probes are seemingly layered on top of each other, i.e., the fabric basis of the instrument is reinforced. Filled with lead B. are no longer used in radiology, since opaque for X-ray bougies and catheters are obtained by introducing bismuth and lead salts into the varnish of the elastic fabric. Here one must also mention therapeutic B., representing soft B. with a layer of ointment applied to them, melting at body temperature. For the same purpose Casper invented metal B. with grooves for ointment. They do not enjoy any widespread use. Besides urology, B. are used in other branches of medicine. Surgeons use B., usually of the soft elastic type, for dilating strictures of the esophagus and rectum; gynecologists use metal B. for dilating the cervix and uterine canal (see Dilators). For the same purpose, water-swelling Stipites tupelo (sold in sterilized packaging), pressed sponges, etc., were used earlier, but now they have been displaced from use by metal instruments. Specialists-laryngologists and otologists bougienize the Eustachian tube with Weber-Lille B., type filiform urological, which are introduced through the nose with the aid of a catheter for blowing up the tube of the Politzer type. Finally, in the treatment of eye diseases the lacrimal-nasal canal is often bougienized with metal B. according to Anel, Bowman, and Weber (see figure 10-15). Storage and sterilization of metal B. do not differ from the methods accepted for other surgical instruments. Boiling is a simple and reliable method of their disinfection. Soft instruments (elastic), on the contrary, require completely special handling. First of all, upon longer storage in air and light they dry out and become sticky-give cracks and break. Therefore, it is better to store them wrapped in waxed paper, in a tightly closed box. During sterilization they do not withstand boiling and spoil very quickly, lose the varnish and become rough. Only white B., formerly of the firm Porges, can still boil for a very short time in plain water without soda; all other bougies do not withstand this. Sterilization with live steam, proposed by Casper, provided the bougies are wrapped one by one in a cloth or towel, is better tolerated, but the instruments will still be short-lived and soon lose their elasticity, a very valuable quality for elastic B. Simple washing with soap is insufficient, and alcohol and carbolic acid solutions dissolve the varnish and quickly spoil the polish. Soft instruments can still be treated with a solution of corrosive sublimate, but after this it is necessary to wash them thoroughly in sterilized water or physiological solution to remove the residue of corrosive sublimate, even in very weak solutions, which is extremely irritating to the mucous membranes of the urinary tract. Silk instruments can be sterilized by boiling in a concentrated solution of ammonium sulfate, which damages them much less than plain water, but their appearance suffers greatly from this. The least harmful method for instruments is disinfection with formaldehyde vapors, proposed by Frank and consisting in placing B. for 24 hours in a glass cylinder, at the bottom of which either ordinary 40% formaldehyde solution is poured, or (which is better) three formaldehyde tablets are placed, which, evaporating, saturate the air in the jar with dry formaldehyde vapors. Before use, especially in the first case, the instruments must be rinsed with water, since formaldehyde concentrates on their surface; without this precaution the instrument causes severe constriction and irritation of the mucous canal. The inconvenience of sterilization with formaldehyde lies in the length of the entire procedure, which is largely eliminated by combining the action of formaldehyde vapors with heating. On this principle is built the sterilizer of Albarran, which itself generates formaldehyde vapors by oxidizing evaporating methyl alcohol on red-hot spongy platinum. A simpler device for rapid sterilization with formaldehyde and heating was proposed by Adrian and consists of a high metal pot on legs, with an inner cup and holes for hanging B. and catheters, a tight lid and a thermometer. A small layer of 2% formaldehyde is poured onto the bottom of the pot and heated with an alcohol lamp until the temperature rises to 60-70°. Then heating is stopped and the device is allowed to cool, after which sterilization is complete. Of course, after such sterilization the B. must be thoroughly washed in sterilized water, as indicated above. For introduction into the canal B. must be lubricated. Sterilized vaseline, almond, Provencal, and vaseline oils are used. All these substances are inconvenient in that they are insoluble in water and therefore are poorly washed off, and by covering the instrument with a layer during sterilization, especially cold, they hinder the successful course of this process, protecting bacteria from the action of the agent. Moreover, soft B. lose their gloss and elasticity from all oily substances and become too soft. Therefore, it is better to use glycerin or Casper's paste (see Catheters) for lubricating bougies, which dissolve in water.