1256 



URETHRA. 



clitoris, and becomes surrounded by two folds 

 of skin which form its sides. 



In the male, the two folds of skin which 

 correspond to the labia majora become blended 

 together, and form a projecting ridge, called 

 the raphe ; they also form the scrotum. The 

 penis continues to increase in size, but the 

 groove which runs along its under-surface as 

 far as the glans, remains patent until the four- 

 teenth or fifteenth week, when its sides swell 

 out and adhere together, and hence the 

 urethral canal, which is completed about the 

 fifteenth week. The prepuce is formed at the 

 fourth month, and at this period the orifice of 

 the urethra appears in the form of a small slit 

 at the extremity of the glans, but it is com- 

 pletely closed at first. 



At the period of birth the pelvic portion of 

 the urethra is more vertical than in the adult, 

 in consequence of the position of the bladder, 

 a great part of which is now situated in the 

 abdomen ; the bulbous portion is situated at 

 a greater distance from the anus than after- 

 wards. 



The rudiments of Cowper's glands are 

 formed at a very early period, on each side of 

 the genito-urinary passage. 



PATHOLOGY. Under this head are in- 

 cluded, first, all deviations from the normal 

 condition arising from arrest of development ; 

 secondly, all changes in the direction and con- 

 dition of the urethra depending on disease. 

 The first are necessarily congenital, the second 

 acquired. 



Congenital malformations. The urethra is 

 seldom altogether absent: it is, however, 

 wanting in cases of decided cloacal formation, 

 and in the female, where there is partial 

 deficiency of the bladder (ectrophy) ; but in 

 those cases in which the urachus remains 

 patent, and where the urine is discharged by 

 tiiis canal, the urethra is always met with. 



The urethra sometimes runs along the 

 dorsum of the penis in the form of a broad 

 groove. This malformation is termed epispadias, 

 from the Greek word tinmrdui, in contradis- 

 tinction to hypospadias, from uiroairdM, sub- 

 tra/io, as in the latter malformation the penis 

 is drawn down. 



Epispadias is frequently complicated with 

 ectrophy of the bladder, but often exists in- 

 dependent of this congenital malformation. 



In either case there is generally consider- 

 able diastasis of the symphyses pubis, the 

 bones being united together by a long inter- 

 vening ligamentous structure. In epispadias 

 there is also a deficiency in the superior part 

 of the prostate gland, the lobes of which are 

 seen only below, and the veru montanum is 

 found in its usual situation ; the prostate is 

 generally smaller than common; the penis 

 also is but imperfectly developed. The urethra 

 itself forms a mere superficial channel along 

 the dorsum penis; it is copiously supplied with 

 large lacunae, the corpus spongiosum is want- 

 ing above, and the glans is cleft; the prepuce 

 ceases at the corona glandis. 



In a case which I recently examined, the 

 bladder was small, and, as if to supply the 



deficiency in the muscular apparatus of the 

 membranous part of the urethra, which was 

 necessarily wanting, the acceleratores urinae 

 were immensely developed ; their superior 

 attachment was of course deficient. 



Hypospadias implies that form of malforma- 

 tion in which the urethra runs in a groove 

 beneath the penis ; it is subject to considerable 

 variation. The most common variety is that 

 where the urethra forms a simple groove, and 

 the penis is bent downwards, the prepuce being 

 wanting. If this groove be continued down 

 deeply to the perinasum, between the two sides 

 of a fissured scrotum, the whole genital system 

 takes on more or less of the female character, 

 and hence has arisen the false notion of the 

 subject of hermaphroditism. 



There are many modifications of this mal- 

 formation. Otto* mentions one case where 

 the penis was cleft, and the vestige of the 

 divided urethra was easily recognised, a fossa 

 navicularis being distinguishable on either side, 

 as well as the termination of an ejaculatory 

 duct. The prostate was wanting. Some- 

 times the urethra is perfect in the glans, and 

 throughout the remainder of its course it is 

 open beneath the penis. 



The urethra sometimes terminates before it 

 reaches its usual destination. Thus it opens 

 into the rectum, or into the perineum; in 

 other cases it goes no further than the root 

 of the scrotum ; sometimes it ends at the 

 corona glandis, or it may end at any distance 

 between this body and the bulb. Occasion- 

 ally the opening is altogether wanting (atresia 

 urethrei), or it is covered by a delicate fold 

 of skin. When it terminates in any of these 

 unusual situations, the opening is very small, 

 sometimes so small as not to admit the in- 

 troduction of a bristle. Now and then we 

 meet with a rudimentary meatus in the usual 

 situation, terminating in a cul-de-sac, and 

 beneath this a small urethral orifice. When 

 the urethra ends at the corona glandis, the 

 prepuce is imperfect ; it is thrown into a fold 

 resembling the hood of a monk, and is 

 hence denominated the monk's hood prepuce, 

 and the glans is uncovered. 



Deviations in diamater, although occasion- 

 ally congenital, are generally the result of 

 disease. A preternaturally contracted state 

 of the urethra is sometimes found at birth. 

 This may happen at the orifice as before men- 

 tioned, or in other parts of the canal. Under 

 this condition, the bladder, ureters, and pelves 

 of the kidneys are sometimes dilated, as in 

 ordinary cases of stricture, f Congenital stric- 

 ture of the urethra is nevertheless exceedingly 

 rare. 



Diseases and accidents. Dilated urethra is 

 not uncommon as the consequence of stric- 

 ture. When the bladder is unable to get rid 

 of its contents, the inordinate efforts to 

 overcome the resistance occasion sometimes 

 a gradual dilatation of the urethra behind 

 the seat of stricture. This condition is at- 



* Monstrorum Sexcentorum Descriptio Ana- 

 toniica. 



f See article TERATOLOGY. 



