PRACTICAL CONSIDERATIONS: MALE URETHRA. 1927 



orrhoidal and the inferior vesical ; the membranous portion from the inferior hem- 

 orrhoidal and the superficial perineal ; and the spongy portion from the bulbar, 

 cavernous, and dorsal arteries from the internal pudic. In the female the urethra is 

 supplied by branches from the inferior vesical, the uterine, and the internal pudic for 

 the upper, middle, and lower thirds respectively. 



The veins, which form a rich plexus beneath the mucous membrane, in the 

 proximal part are tributary to the vesical and prostatic veins, and in the spongy por- 

 tion to the dorsal vein of the penis and the internal pudic veins. In the female the 

 veins empty into the vesico-vaginal and pudendal plexus. Below they communicate 

 with the venous spaces of the clitoris and the bulbus vestibuli (Waldeyer). 



The numerous lymphatics within the mucous membrane form a proximal and a 

 distal set. The former pass backward to join the lymphatics of the vesical trigone, 

 the latter course forward and unite with those of the glans. The lymph-tracts from 

 the spongy and membranous portions of the urethra communicate with the internal 

 or pubic group of inguinal lymph-nodes ; those from the prostatic portion are affer- 

 ents to the internal iliac nodes. In the female the lymphatics from the upper part of 

 the canal pass to the internal iliac nodes ; below they empty into the lymph-vessels 

 of the labia minora and communicate with the inguinal nodes. 



The nerves are from the pudic, which conveys sensory fibres to the mucous 

 membrane and motor fibres to the striped muscle, and from the hypogastric plexus 

 of the sympathetic by way of the prostatic and cavernous plexuses. 



PRACTICAL CONSIDERATIONS: THE MALE URETHRA. 



Congenital abnormalities of the urethra are not common. Absence of the urethra 

 usually causes death of the foetus before birth, as urine is secreted and enters the 

 bladder during intra-uterine life, the vesical distention then causing pressure upon 

 the umbilical arteries and embarrassment of the foetal circulation. Atresia of the 

 urethra may be found at birth at any point in the canal, but if posterior to the meatus 

 is apt to result in death of the foetus. Occasionally it affects only the meatus, the 

 mucous membrane of the glans presenting no orifice, but either yielding spontane- 

 ously to the child's efforts to urinate or being readily penetrated by a probe. 



Contraction of the meatus so that it will admit only the finest probe is a not 

 uncommon congenital condition, is often associated with phimosis, and may cause a 

 sufficient degree of urinary obstruction and of reflex irritation of the susceptible 

 nerve-centres of an infant to require meatotomy (q. v. ). 



Hypospadias. This is a congenital deficiency in the lower wall of the urethra 

 which may terminate at the perineo-scrotal junction or at any point anterior to it. 

 The varieties of hypospadias are described in accordance with the degree of arrest 

 of development (page 2040) which has occurred. If this has been extreme, the 

 anterior orifice of the urethra may even lie in the perineum, the two halves of the 

 scrotum remaining ununited, and often consisting of two separate pouches, which are 

 empty when the testicles have failed to descend, and which, therefore, resemble 

 strongly the external genitalia of the female. In these cases the penis is atrophied 

 and is closely applied to the fissure in the scrotum. In the peno-scrotal variety the 

 opening is at the junction of the anterior fold of the scrotum with the inferior surface 

 of the penis, and the latter is apt to be somewhat better developed, although still 

 strongly curved downward, owing to its being much shorter on its inferior than on 

 its upper surface. In the penile variety of hypospadias the urethral opening may 

 be at any point on the lower surface of the penis between the peno-scrotal junction 

 and the corona glandis. In the so-called balanic hypospadias the opening of the 

 urethra is situated on the under surface of the glans ; the frenum is absent. There 

 is often a. little groove at the anterior extremity of the glans w r hich resembles the 

 normal meatus, but which usually ends posteriorly in a blind pouch. When the 

 urethral orifice is situated far back, the patient is usually sterile, although not neces- 

 sarily impotent if the organ is well developed. Often, however, it is so rudimentary 

 or so markedly curved upon itself that intercourse is impossible. The forms of hy- 

 pospadias involving the glans are of no physiological importance and require no 

 treatment. 



