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For hard tunnel strictures and in cases of perineal fistula we should be bolder to adopt the principle of excision rather than that of mere external urethrotomy.
A preliminary suprapubic cystotomy is advised, and also the avoidance, as far as possible, of the indwelling catheter. All fistulæ should be excised completely, not merely opened, scraped and drained.
The operator should not be in too great a hurry to pass sounds of too large a calibre after the operation, as in many cases there is little tendency to re-formation of the stricture.