URETHRA. 



1257 



tended with excessive irritation along the 

 whole course of the canal, and the prostate 

 gland becomes hypertrophied in consequence. 

 Sir Benjamin Brodie mentions a remarkable 

 case of this description. In this case the 

 urethra, behind the obstruction, was so di- 

 lated, that, whenever the patient attempted to 

 pass his urine, a fluctuating tumour, as large 

 as a small orange, was felt in the perinaeum. 

 It was punctured, and immediately the urine 

 gushed out in a full stream. 



The escape of .calculi from the bladder 

 often occasions dilatation of the urethra into 

 pouches ; and such dilatations occur inde- 

 pendent of ulceration. 



On dissection of these pouches, the mucous 

 membrane is usually found injected and 

 thickened, presenting fungous vegetations, 

 and occasionally coated with lymph. 



The urethra deviates frequently from its 

 normal direction : thus, in large scrotal hernias, 

 and hydroceles of large size, it takes a ser- 

 pentine course : so also, when tumours press 

 on the canal, its course is altered. The same 

 happens in enlargement of the prostate gland, 

 and from the projection of its middle lobe, 

 the urethra divides itself into two streams. 

 Abscesses also distort the canal from its na- 

 tural direction. Tumours in the pelvis, as a 

 collection of hydatids between the bladder and 

 rectum, in consequence of the influence they 

 exert on the bladder, frequently distort the 

 urethra from its normal direction. This dis- 

 tortion occurs more especially to the pelvic 

 part of the canal. Under these circumstances 

 the urethra is generally lengthened to a greater 

 or less extent. 



Solutions of continuity result either from 

 mechanical injury, or from disease. The urethra 

 may be wholly or in part divided. Most 

 commonly, if the division be incomplete, a 

 small fistulous opening remains for a short 

 time, which subsequently, if let alone, com- 

 pletely closes. Incisions through the mem- 

 branous part of the urethra, as in the opera- 

 tion of lithotomy, speedily cicatrise. 



The most serious injuries to the urethra 

 are those resulting from blows or falls on the 

 perinaeum, especially when they are accom- 

 panied by fracture of the ossa pubis. In these 

 cases there is either partial or complete solu- 

 tion of continuity. The membranous part of 

 the urethra, from its position beneath the 

 pubic arch, most frequently suffers. The na- 

 ture of the injury may be generally recognised 

 by the escape of blood with the urine, or by 

 complete retention of urine. An elastic ca- 

 theter, carefully introduced, will in the former 

 case generally grate against the torn part In 

 complete division of the urethra, if the patient 

 survive the injury, the torn ends are, in 

 the progress of the cicatrisation and con- 

 traction, brought into apposition, and the con- 

 tinuity of the tube is restored : stricture is 

 the almost necessary consequence. If, how- 

 ever, the cure is not accomplished, urinary 

 fistula is the unfortunate result. When the 

 complete division of the urethra is accom- 

 panied with fracture of the pubis, the two 



ends of the canal are frequently so completely 

 separated, that extensive extravasation of urine 

 ensues, and the case is generally fatal. 



Severe contusion of the urethra, inde- 

 pendent of rupture, sometimes leads to ul- 

 ceration or sloughing, and occasionally gives 

 rise to stricture by inducing chronic inflam- 

 mation of the injured part. 



Laceration of the urethra occasionally hap- 

 pens from the introduction of foreign bodies, 

 or from the escape of fragments of calculi, 

 especially after the operation of lithotrity. 

 The torn part generally heals under simple 

 treatment, or the urine is infiltrated into the 

 spongy body, and abscess is the consequence. 

 Laceration often attends violent efforts to 

 force a stricture with the sound or catheter : 

 these injuries usually happen at the under 

 part of the canal, and frequently heal if all 

 violence be desisted from. In a case of la- 

 cerated urethra brought into the London 

 Hospital, a large pouch as big as a small 

 orange was formed in the scrotum, into which, 

 when the man attempted to micturate, the 

 urine was forced ; he then squeezed it through 

 the natural pnssage. By degrees this pouch 

 gradually contracted, and no vestige of it 

 remained . 



Inflammation of the urethra, whether com- 

 mon or specific, is usually of the catarrhal 

 form : common inflammation is comparatively 

 rare ; but it may be excited by chemical and 

 mechanical stimuli, or it may depend entirely 

 on constitutional indisposition : thus strong 

 injections have been known to induce every 

 symptom of severe urethritis simulating an 

 attack of gonorrhoea; but the disease is speedily 

 arrested by ordinary antiphlogistic treatment. 

 Under the head of mechanical causes may be 

 enumerated the introduction of the catheter 

 or bougie, and other foreign bodies, and the 

 passage of calculi entire or in fragments, and 

 blows on the perinaeum. 



The urethra is sometimes inflamed from 

 constitutional causes, or sympathetically : thus 

 stone or calculus in the bladder and kidneys 

 frequently leads to urethritis ; some substances 

 taken into the stomach produce the disease, 

 as asparagus, cantharides, and turpentine, and 

 arsenic if administered in large doses, espe- 

 cially if the poison be allowed to accumulate 

 in the system. 



In persons of a gouty diathesis, urethritis 

 occasionally occurs, followed by a discharge 

 of muco-pus. According to Prout, "gouty 

 irritation of the urethra often assumes all the 

 characters of gonorrhoea, and is not only 

 attended by a profuse discharge, but with 

 great irritation and scalding in passing water." 

 During the prevalence of influenza, I have 

 witnessed a severe attack of urethral inflam- 

 mation accompanied with copious puriform 

 secretion, and attended with the ordinary 

 symptoms of clap ; under the influence of a 

 purge it passed off entirely in a few days. 

 Suppression of cutaneous eruptions, according 

 to the German pathologists, not unfrequently 

 causes urethritis. Inordinate indulgence in 

 vcnery, and masturbation, produce inflamma- 



