Urethroscope.

Application filed October 15, 1910. Serial No. 587,231.

To all whom it may concern:

Be it known that I, Ferdinando Cerbo, a subject of the King of Italy, residing at Providence, in the county of Providence and 5 State of Rhode Island, have invented certain new and useful Improvements in Urethroscopes, of which the following is a specification.

.The improved device forming the subject 19 of this application for patent relates more particularly to urethroscopes or analogous tubular instruments, adapted to be inserted into the urethra, and as employed by physicians, for the purpose of making examina15 tions, as well as treating the walls or membrane of the urethral passage or other channels, and it consists in the novel construction and combination of the parts or elements comprising the instrument, all as 21 more fully hereinafter set forth and claimed.

There are inherent disadvantages or objections to instruments or devices of the general character or type referred to and as heretofore produced: That is to say, the 2 3 physician who.uses the latter in his practice must necessarily provide himself with a plurality or set of the instruments, varying in size, capacity, &c., corresponding with variations in the size of urethral passages, C a thus materially increasing the cost of equipment; the patient is subjected to additional pain and discomfort owing to the fact that the instrument produces a continuous dilation of the urethral channel during its ini'5 sertion; the area of visual examination of the surrounding membrane or tissue at the inner or lower end of the instrument when in use is comparatively restricted; the central space or cross-sectional area through 40 which forceps operations are effected is materially contracted; and the construction of the instrument is such that it is practically impossible to properly expand the walls of the passage for the purpose of irrigation 45 and treatment, since the device is unprovided with means for temporarily dilating the folds of the mucous membrane after the instrument is in place. It may be added that instruments of this class are each usually 50 provided with a small independent electric lamp, capable of being inserted in the tube at will, and having the switch or circuitcloser located exterior of and disconnected from the instrument.

The objects sought to be attained in the present invention are to produce a simple and comparatively inexpensive, self-contained instrument or urethroscope in which the disadvantages or objections above referred to are wholly eliminated. By means g<) of this improved construction, the one instrument alone is readily adaptable to urethral canals varying in size, the diameter of the outer tube corresponding, say with the minimum diameter of the canals. The 33 tube carries at its inner or lower end a plurality of normally closed, converging, swinging members, termed dilators, capable of being readily opened and closed at will. To the inner side of one of the dilator members 70 is secured a small electric lamp bulb, its leading-in wires being arranged to contact with the poles of a suitable miniature inner switch located at the terminal of the branch current-conducting wires of the circuit. 75 Means are also provided for introducing treating or irrigating remedial fluids into the instrument. The improved construction readily permits of the unobstructed insertion and employment of a magnifying lens, so

By means of this improved urethroscope, the. same when inserted as in use may be easily and quickly manipulated so as to accurately and positively open all the dilators simultaneously to the desired extent, thereby S5 correspondingly enlarging that portion of the urethral passage and temporarily producing a complete dilation of the folds of the membrane of the cavity, preparatory to examination, forceps operation, irrigat- 90 ing or other operation. The act of swinging open or separating the dilators also automatically closes the electric circuit and energizes the lamp, thus illuminating the adjacent surfaces. After completing the ex- 95 amination, treatment, &c., of the corresponding portion of the urethra, the act of moving the dilators back to the normal or closed position automatically opens the switch of the said electric circuit and extinguishes the 100 light, followed by withdrawing the instrument from the urethral channel.

In the accompanying sheet of drawings, Figure 1 represents a side elevation of the improved urethroscope, somewhat enlarged, 105 the dilators being in the normal or closed position. Fig. 2 is a longitudinal central sectional view of the same, further enlarged. Fig. 3 represents a view of the front or head end, corresponding with Fig. 2. Fig. 4 rep- 110 resents the opposite or lower end of the device. Fig. 5 is a cross-sectional view, taken

1,003,232 on line 5 5 of Fig. 2. Fig. 6 is a partial, longitudinal, central sectional view, still further enlarged, showing the dilators normally closed, corresponding with Fig. 2. 5 Fig. 7 is a similar sectional view, showing the dilators open or expanded; and Figs. 8 and 9 represent cross-sectional views, taken on lines 8 8 and 9 9 of Figs. 6 and 7, respectively.

A, again referring to the drawings, designates the improved urethroscope as a whole, the same consisting essentially of the relatively stationary outer tube a; the non-revoluble, but longitudinally movable inner 15 tube b; a plurality of swinging, laterally movable dilators or wings d jointed to the lower end of tube a, each having a short arm or member p engageable with the lower end portion of the inner tube b through a 20 slot o, and means operatively connected with the upper or head portion of the instrument constructed and arranged whereby the practitioner or user may open and close, or actuate the dilators as desired. All the 25 above named elements may be made of German silver or other suitable metal or material.

The diameter and length of the outer tube a may have any proper or suitable dimen30 sions, such, for example, as will permit the instrument to be readily inserted into the urethral passage. One end portion of the tube, which may be termed the upper or head end part, is provided with a compara35 tively large, transverse circular flange f and the slightly enlarged tubular cylindrical head a¹, the latter, as shown, being screwthreaded interiorly to receive and cooperate with an annular screw e, soon to be de40 scribed. The said flange f has a radial lug or boss f² on its under side, in which a short tube t is fitted for conducting remedial fluids into the instrument. The flange is also provided with an extension having a compara45 tively wide, radial groove or gutter the same being located diametrically opposite the lug /’², all as clearly shown in Figs. 2 and 5. To the lower end of tube a are pivoted or hinged, at Λ, four circumferen50 tially spaced, thin, elongated, tapering members d. These latter, which are termed dilaators, when normally closed, as indicated in Figs. 1, 2, 4, 6 and 8, are substantially coneshaped, each being concavo-convex cross55 sectionally. The free or apex end iZ¹ of each dilator is slightly enlarged, the arrangement being such that when the said ends d¹ are in actual engagement with one another a narrow, longitudinal, unobstruct60 ed space f is formed between the adjacent edges of each pair of dilators,—see Figs. 4 and 8. As thus constructed, the act of closing the dilators serves, when in use, to pre· vent the folds of the adjacent mucous mem65 brane from being injured or caught and pinched or confined between them. The non-revoluble central inner tube b, through which the several treating operations are or may be effected, has an unobstructed, relatively large bore m throughout its length; 70 it is supported in the outer tube a, and is capable of longitudinal movement therein. The lower end of tube b normally extends to or slightly below the corresponding end of tube a, its wall being provided with four 75 small, circumferentially spaced, elongated openings 0 to receive the short arms p of the said dilators. The inner or lower end of said small tube t extends into an elongated opening &¹, Fig. 2, formed in the adjacent 80 side of the central tube. The member t serves to conduct fluid into the instrument and also acts to prevent the tube b from turning on its axis, while freely permitting the latter to move endwise. At a point 85 above the flange f the tube b is provided with an outer shoulder b². The upper end of this tube has an annular disk c secured thereto. To the cylindrical part of the tube, lying between said shoulder and disk, is 90 revolubly mounted the annular screw e, fitted to the tapped or screw-threaded portion of the head a¹ before described. In order to facilitate the manipulation of the screw, the latter is provided with the thin^ 95 disk-like member e¹, having, say a milled or reeded edge, all as clearly shown in Figs.

and 2. The screw-thread employed may be of very fine pitch and of the micrometer type, thereby adapting it for greater ac- 100 curacy and nicety of adjustment.

The upper end of the tube b may be provided with a flat, swinging cover i mounted . on the disk c for closing the tube’s central passage m when desired. See also Fig. 3. 105 As drawn, the cover’s pivot or post i¹ is extended and adapted to removably support a suitable examination lens or magnifying glass mounted, as usual, in a frame, as B, Fig. 2, and capable of being employed for 110 obvious purposes.

The following describes the manner of mounting and controlling the electric lamp employed in connection with the instrument. The lamp proper, Z, is suitably positioned 115 and secured to the inner or concave side of one of the dilators, say at a point comparatively near its pivot or joint h; suitable packing or heat-repelling material u being interposed between the lamp and deflector. 120 The fine current-conducting wires from the lamp may be suitably secured to a contiguous, immovable switch member s. The current-conductors or poles n¹, n², Fig. 2, of the branch circuit may be insulated and 125 threaded into a small, slightly flexible tube n, which in turn may extend through the disk c, and then longitudinally of ana fixed to the Avail of the inner tube b, its lower end being supported in a guide u¹, Fig. 6, fixed 130

1,003,232 to said dilator and terminating in a switch member s¹. As thus devised and constructed, the act of turning the screw e in the proper direction forces downward bodily and endwise the tube 5 and the tube n, carrying the energized, current-conducting wires, the result being to positively advance the members s¹, in which the said wires terminate, across the normally open gap, thus automatically closing the circuit and energizing the lamp.

Fig. 6 represents the relation of the parts corresponding to an open circuit, and Fig. 7 the same when closed. It may be added that the wire-carrier n flexes sufficiently between the guide ih and the lower end of the central tube to permit the movement of the member s¹, as in opening and closing the switch. The current used may be generated in a small portable battery (not shown) adapted to be detachably secured to the instrument.

Novy assuming the normal relation and adjustment of the several parts comprising the improved urethroscope A to be substantially as represented in Figs. 2, 3, and 6, the manner of its use and operation may be described as follows: The instrument is first inclined and inserted in 'the urethral passage to the desired depth or extent, followed by turning the screw e, thereby correspondingly moving the central tube δ and its wire-carrier n bodily downward or endwise (see arrow; x, Fig. 6) until the upper edges of the several openings o of the tube engage the adjacent sides of the respective short dilator-arms p, thereby automatically closing the switch; that is, the poles of the member s¹ are then in electrical contact with the poles of the fellow member s, thus energizing the lamp I. Up to this point, however, the dilators remain normally closed. Now a further movement of the screw acts, through the medium of the tube b and arms p, to simultaneously swing the dilators outward or laterally, thereby correspondingly distending the walls or membrane of the adjacent portions of the now illuminated urethral cavity. The physician may then make a visual examination or inspection of the thus acted upon parts. The clear central passage m also readily permits of the introduction and use of such implements as the case may require or warrant. In case it is deemed advisable to apply remedial fluids to the membranous Avails, the liquid may be conducted downward from a suitable source of supply (not shown) via a flexible pipe d to the tube t and into the urethroscope—see arroAvs Fig. 2. Of course, the cover i is first SAVung so as to close the hole m, while the flushing or irrigating treatment is being effected; the head or pressure upon the fluid insures its circulation and causes it to thoroughly cleanse the affected or diseased tissues, the Avaste or used liquid flowing upward along the canal and around the exterior of tube a, and is deflected by the flange /, as it is discharged from the urethral passage into 70 the groove or gutter /¹. As thus devised, it is obvious that the membranous Avails of the cavity in which the instrument is inserted may be safely, easily and expeditiously distended through the medium of 75 the dilators to any desired degree or extent, as determined by the judgment of the experienced physician.

At the completion of the operation the act of turning the screAV e to retract the 80 tube δ back to its normal position first moves the latter until the loAver edges of the several openings 0 engage the adjacent under sides of the said short dilator-arms p, thereby automatically causing the mem- 85 ber s¹ of the SAvitch to be AvithdraAvn from the member s, thus separating the poles and again opening the electric circuit and extinguishing the light at the same instant; the further or continued movement of the 90 screAV now acts to simultaneously contract or swing the expanded dilator members cl inward toAvard one another until they are fully closed and in the normal or coneshaped position, after which the instrument 95 is removed from the patient, thus completing the operation.

It may be added that while the instrument forming the subject of this application for patent is termed a urethroscope, it 100 is obvious that, without departing from the spirit of the invention, the device may be readily adapted and employed as an endoscopic tube for the examination of other passages, as for example, vaginal, rectal, 105 aural and nasal canals. In such cases, however, the form and size of the parts or elements comprising the instrument may be varied or changed in order to adapt it to the canals named. no