THE PELVIC CAVITY IN THE MALE. I4g 



was much more important formerly, when it was the practice to enter the bladder by puncture 

 through the anterior rectal wall, than now, when such a procedure is rarely, if ever permissible 

 The posterior surface, fundus or base of English writers, and the pubic surface are scarcely 

 changed by any degree of distention. ED.] 



The Ureter.-The pelvic portion of the ureter (Fig. 71), after crossing the iliopectineal 

 line, runs beneath the peritoneum in the lateral pelvic wall along the internal iliac artery; it 

 then passes inward and forward to the fundus of the bladder, being crossed by the vas deferens, 

 which passes backward and inward [. e., the vas crosses on the vesical side of the ureter. ED.].' 



The Male Urethra. In the flaccid penis the urethra forms an S-shaped curve and is 

 fifteen to twenty centimeters in length. The first or postpubic curve is situated behind the 

 symphysis and its concavity is directed forward and upward. This curve must always be borne 

 in mind during the introduction of a catheter, sound, or cystoscope for the purpose of diagnosis, 

 irrigation, or internal illumination of the bladder (cystoscopy), since it does not disappear when 

 the penis is elevated. The second or subpubic curve is situated beneath the symphysis, its 

 concavity is directed downward and backward, and it disappears upon elevation of the penis. 

 The urethra is subdivided into three portions the prostatic, the membranous, and the spongy 

 (pars prostatica, membranacea, and cavernosa urethra;) . The urethra possesses three wide 

 and two narrow places : 



The three wide places are: (i) The pars prostatica; (2) the recessus bulbosus, a dilatation 

 situated in the commencement of the pars cavernosa, which may occasionally catch the end of 

 the catheter; and (3) the fossa navicularis, just behind the external orifice. 



The narrow portions of the urethra are: (i) The pars membranacea, the muscular wall of 

 which opposes the introduction of an instrument by reflex contractions; and (2) the meatus, 

 behind which small calculi may become impacted after they have escaped from the bladder. 

 [It is worth noting that, in normal urethras, an instrument which passes the external meatus 

 may be expected to pass the other narrowed portions without difficulty. ED.] The internal 

 orifice of the urethra is also not infrequently narrowed and causes difficulty in urination, par- 

 ticularly when the middle lobe of an hypertrophied prostate presses against the orifice. [The 

 effect of enlargement of the middle lobe of the prostate is to create a bar behind the urethra 

 and to so change the relation that the bladder opening of the urethra does not correspond to the 

 lowest level of that organ, as it should; the result is that the bladder cannot be completely 

 emptied, more or less urine remaining residual urine. It also changes the length and curve 

 of the prostatic urethra, which must be remembered in attempting to catheterize these cases. 

 ED.] From the relation of the prostate to the rectum it will be understood that prostatic inflam- 

 mations and abscesses may extend posteriorly and break into the rectum. The chief seat of 

 urethral stricture is at the junction of the cavernous with the membranous portions. From 

 the study of a median sagittal section it will be clear that the retained and decomposing urine 

 above the stricture may give rise to inflammation and suppuration which may perforate into 

 the rectum, into the scrotum, or through the perineum. It should also be noted that the urethra 

 may be opened by making an incision in the perineal raphe, in the median line, and dividing 

 the skin, the tunica dartos, the superficial perineal fascia, the bulbocavernosus muscle, and 

 the bulbus urethra;. Finally, it should not be forgotten that in gonorrhea the anatomic rela- 



