[From The Johns Hopkins Hospital Bulletin, No. 84, March, 1598.] 
THE CATHETERIZATION OF THE URETERS IN THE MALE 
THROUGH AN OPEN CYSTOSCOPE WITH THE BLADDER 
DISTENDED WITH AIR BY POSTURE. 
By H. A. Kelly, M. D., 
Gynecologist-in-Chief to The Johns Hopkins Hospital. 
The. difficulties and the dangers of the various devices for 
electric cystoscopy with the source of illumination introduced 
within the bladder are so great that I feel sure urologists 
everywhere will welcome and test carefully any new method of 
examination which bids fair to limit or to supplant these 
methods by one which is simpler, more direct and more satis- 
factory in its results. 
I have succeeded in devising such a method and in demon- 
strating its utility in the presence of an audience of expert 
urologists and surgeons at St. Luke’s Hospital, New York 
City, Feb. 4th, 1898, through the kind invitation of Dr. L. 
Bolton Bangs, consulting surgeon, and the courtesy of Dr. 
Kobt. Abbe, visiting surgeon, who offered me his clinic hour. 
Among the visitors present were Drs. Kobt. F. Weir, Willy 
Meyer, Clement Cleveland, Kobt. A. Murray, Farquhar B. Curtis, 
F. Tilden Brown, and others. 
I was greatly indebted to the house staff of the hospital for 
their warm, intelligent interest and assistance throughout. 
Dr. Otto G. Ramsay accompanied me from the Johns Hopkins 
Hospital and aided me skilfully at every step of the investi- 
gation. 
The cystoscope used was a straight metal nickel-plated tube 
15.5 cm. long, 7 mm. in diameter, the caliber being equal from 
end to end, except at the conical external orifice, which meas- 
ured 2.7 cm. at its outer border and was blackened on the 
inside to prevent the reflection of the light from obscuring the 
field. A stout handle 10 cm. long was attached to the outer end. 
The source of illumination was a small electric headlight, 
deriving its current from the house supply, reduced by a Yetter 
controller. The patient, a yonng man, was put under SchleiclTs anes- 
thetic, when I introduced the cystoscope armed with its obtu- 
rator as far as the prostate, and then guided it easily over the 
prostate and into the bladder by raising and guiding the end 
with one finger introduced into the rectum. The penis, of 
average size, shortened on the cystoscope to a length of about 
5 cm. 
He was then carefully turned over and placed in the knee- 
chest posture and brought to the edge of the table and the 
obturator withdrawn; air at once entered the bladder and the 
investigation was made. 
The light was good and the base of the bladder at once 
came clearly into view; the posterior wall was seen by ele- 
vating the handle a little, then by turning it to the right and 
to the left the left and right lateral walls were clearly seen. I 
then withdrew the speculum until the internal urethral orifice 
began to close over it, and then pushed it in a little, turned it 
about 30 degrees to the left and dropped the handle, when the 
right ureteral orifice came clearly into view, as clearly as I 
have'ever seen it in a woman. 
Dr. Willy Meyer looked through the cystoscope and agreed 
it could not have been seen clearer or more unmistakably if it 
had been on the surface of the body. 
Dr. Ramsay then handed me one of my renal catheters, 
50 cm. long and 2 mm. in diameter, armed with a stylet, and 
this was guided, after two attempts, up into the ureteral orifice, 
and easily stripped of the stylet, into the ureter, ascending up 
to the pelvis of the kidney. Dr. Abbe now looked through the 
cystoscope and saw the catheter entering the bladder wall. 
The patient was then put to bed with the catheter in posi- 
tion, and before leaving the hospital I had the satisfaction of 
knowing that half a test-tube full of slightly cloudy urine had 
been collected. 
By this method of cystoscopy not only is the diagnosis of 
vesical lesions simplified, but simpler and direct plans of treat- 
ment, such as curetting, cauterizing and making applications 
to localized areas are made possible. Small tumors may also 
be easily excised or snared. 
A preliminary note has been published in the Annals of 
Surgery (Jan. 1897), where a fuller account will shortly 
appear.