1260 



URETHRA. 



The urethra is sometimes traversed by 

 cords, in some respects resembling at first 

 sight the cordcB Villisii of the longitudinal 

 sinus. I presume they are formed by organi- 

 sation of effused lymph. There is a curious 

 specimen of this disease in the Museum of St. 

 Bartholomew's Hospital, marked in the Cata- 

 logue 30. 37. The patient from whom the 

 preparation was taken had been frequently 

 the subject of catheterization. The disease is 

 exceedingly rare. 



Stricture. Under this head are enumerated 

 all contractions of the urethra depending on 

 alteration of the tissue of the canal itself, or 

 the parts immediately surrounding it. Stric- 

 tures are commonly arranged under three 

 heads spasmodic, permanent or organic, and 

 inflammatory or irritable stricture. 



A spasmodic stricture may be defined to be 

 a temporary diminution in the diameter of the 

 urethra, sometimes to such an extent as to 

 effect its complete closure, from spasm of the 

 muscles surrounding it. The term can only, 

 with strict propriety, be applied to a tem- 

 porary contraction of the muscles investing 

 the membranous portion, as no action of the 

 acceleratores urinae is equal to the complete 

 closure of the spongy part. The common 

 seat of spasmodic stricture is therefore the 

 membranous part. 



Spasm of the urethra arises from various 

 causes, as exposure to cold, indulgence in 

 wine and venery, and gonorrnceal inflamma- 

 tion. So also, certain medicines, as cantha- 

 rides, when taken into the stomach, or ap- 

 plied endermically, may induce a similar con- 

 dition. 



Although genuine spasm is confined to the 

 membranous part, yet the remainder of the 

 urethra is liable to temporary contraction 

 from general irritation of the mucous surface, 

 as where the urine is loaded with lithates, 

 and hence becomes exceedingly irritating. 

 Under these circumstances the stream of 

 urine is diminished, and the urethra resists 

 the introduction of the catheter. This con- 

 dition probably depends on irritability of 

 those fibres, be they muscular or not, which 

 enter so largely into the structure of the 

 outer layer of the urethra. 



Spasmodic stricture may be recognised in 

 the following manner : a patient observes a 

 sensible diminution in the stream of water, 

 aggravated by drinking and free living. After 

 unusual indulgence in wine or venery, he 

 finds suddenly that he is unable to pass a 

 drop of water ; the surgeon, on attempting 

 to introduce an elastic catheter, which is the 

 best adapted for the case, finds the progress 

 of the instrument impeded at the membranous 

 part of the urethra ; by gentle pressure, how- 

 ever, the spasm yields, and the instrument 

 enters the bladder suddenly, and all sense of 

 contraction disappears. On using the instru- 

 ment on the following day, he finds that it 

 passes with perfect freedom. 



By permanent stricture is understood a 

 narrowing of the canal from organic change 

 in the tissue of the urethra itself, or the corpus 



spongiosum. Permanent stricture may at- 

 tack any portion of the urethra ; even the 

 prostalic part, the fossa navicularis, and the 

 bulb have been the seat of stricture : thus, 

 Ricord and Cross have met with stricture in 

 the prostatic portions, and the fossa navicu- 

 laris has been found to be the seat of the dis- 

 ease (after ulceration) ; but, although it is by 

 no means unfrequent in the spongy portion, 

 it is most common in the anterior part of the 

 membranous part of the canal. This subject 

 has been examined by various writers on 

 urethral diseases, but the most extended re- 

 searches are those of Mr. Phillips, and I 

 therefore append the result of his observa- 

 tions. He selected a number of cases for 

 examination, and he found that 

 In 9 cases the stricture was distant from the 



meatus - - - 1 inch. 

 8 from 1 to 2 inches. 



13 2 to 3 



11 3 to 4 



98 4 to5| 



40 5ito6i 



10 6to7i 



This corresponds with the observations of 

 Ducamp, who found that, in five cases out of 

 six, strictures are found at the distance of 

 about 5 inches from the meatus, or from 4 

 inches 9 lines to 5 inches 3 lines. Amussat 

 states that the most common seat of the dis- 

 ease is the point of junction between the bulb 

 and membranous portions. 



Varieties of permanent stricture. Strictures 

 may be spontaneous or traumatic. Traumatic 

 strictures generally occur at the membranous 

 portion, but they are occasionally found in 

 the spongy part. The former result from* 

 contusions or lacerations, the latter from di- 

 vision of the canal by cutting instruments, as 

 after the extraction of impacted calculi, or 

 after complete division. Whatever be the 

 cause of traumatic stricture, if stricture en- 

 sues after a wound of the urethra, a cicatrix 

 occurs, as in other situations, and a tendinous 

 puckering of the membrane takes place, giving 

 rise to the most intractable form of the dis- 

 ease. If, however, the- stricture results from 

 simple contusion inflammation attacks the 

 part and the stricture is produced as in the 

 common class. After ulceration of the ure- 

 thra from chancre a puckering of the mem- 

 brane gives rise to stricture in its character 

 resembling the ordinary traumatic variety. 



The most simple form of permanent stric- 

 ture is where the urethra is traversed by a 

 fold of membrane thrown across in the form 

 of a bridle. In this case the stricture is 

 usually in the floor of the canal. It may 

 occur in any part, except the prostatic, but its 

 usual seat is the commencement of the spongy 

 portion. The diameter of the urethra is thus 

 only partially occluded, the shape of the 

 stricture being somewhat crescentic. When 

 the urethra is completely encircled, it appears 

 as if a slender thread were tied around it, and 

 thus an annular stricture, or bridle, is formed, 

 the opening being usually in the middle. The 

 efforts to micturate often push forward the 



