41 8 The Urethra 



The association between gleet and stricture is briefly this : chronic 

 urethritis determines the deposit of plastic material in the submucous 

 coat ; this new tissue undergoes atrophy, the result being a con- 

 striction around the tube a stricture. The stricture keeps up the 

 irritation and discharge, so that the only way of curing a gleet may 

 be by the gradual dilatation of the canal to its proper size. It may be 

 necessary to increase the size of the bougie up to No. 13 or 14 of 

 the English scale. The remarkable capacity of the normal urethra is 

 shown by the ease and safety with which Bigelow's enormous litho- 

 trites may be passed. 



The follicular glands of Li lire are more freely scattered along the 

 floor of the spongy urethra ; but the largest of them, the lacuna inagna, 

 is yawning upon the roof of the fossa navicularis. 



In an attack of urethritis, abscess may form in one of these follicles 

 and cause troublesome gleet. Sometimes the abscess breaks on the 

 under surface of the penis. 



When the urethra is at rest its mucous membrane lies in longitudinal 

 rugae. It consists of a basement membrane covered by columnar 

 epithelium ; in the prostatic portion, and in the fossa navicularis, the 

 epithelium is laminated. 



A calculus escaping from the bladder may be impacted in the 

 urethra, plugging the canal, it prevents micturition ; calculus in the 

 urethra is the most common cause of retention of urine in children. 

 But if the stone be too small to completely block the canal, it will 

 probably give rise to irritation and to incontinence of urine! 



In passing a catheter the handle must not be depressed before 

 the beak has entered the depths of the perineum ; but if the handle 

 be not depressed soon enough, the beak will catch against the front of 

 the triangular ligament. The rule is to keep the beak of the catheter 

 along the roof of the urethra, thus the hitch may be avoided. On 

 partially withdrawing the catheter, and then depressing the handle, the 

 end glides over the obstructing ridge. But in the operation no force 

 should be used, lest the end of the instrument pass out of the urethra 

 and enter a false passage : The instrument having been passed to 

 the very hilt, no water flows, only blood escaping ; moreover, the instru- 

 ment cannot be made to roll on its long axis, the point being still 

 tightly held, and, further, perhaps, the handle has swerved from the 

 middle line. 



The error may be detected by introducing the finger into the 

 rectum, when the catheter will be found alarmingly near the bowel, 

 and it may be corrected by withdrawing the instrument the finger 

 being still within the bowel and re-introducing it at a higher level. 

 The accident may be followed by escape of urine on to the front of 

 the triangular ligament, and by perineal abscess. 



If the handle of the instrument be too suddenly and too forcibly 

 depressed, a false passage is sometimes, though rarely, made through 



