Female Urethra 419 



the roof of the urethra, just behind the triangular ligament, the beak 

 passing into the cellular interval between the front of the bladder and 

 the pubes. Blood might escape but no water, and the beak might be 

 clearly felt behind the abdominal wall. Digital exploration by the 

 rectum would not distinguish the catheter in the bladder. 



Rules for catheterisation. Be very gentle. Keep the beak of 

 the catheter along the roof of the urethra. When you can no longer 

 feel the beak in the perineum introduce your finger into the rectum, 

 as a guide and guard. Keep the handle in the exact median line, 

 and in depressing it mind that the beak does not catch against the 

 front of the triangular ligament. Learn, and remember against a 

 future occasion, the geographical peculiarities of that urethra. Should 

 spasmodic contraction of the compressor urethras obstruct the passage 

 of the instrument, pause until the muscle has yielded, and then gently 

 proceed with the operation. 



Cock's operation. When retention of urine results from stricture 

 of the urethra, that part of the canal which intervenes between the 

 prostate and the stricture is (see fig. on p. 408) distended ; if the end of a 

 scalpel be boldly introduced into it the bladder empties itself, and, rest 

 being secured, the stricture ultimately gives way. For the operation 

 the patient must be placed in the lithotomy position, and the finger 

 having been introduced into the rectum, and resting against the apex 

 of the prostate, the scalpel is thrust up to it, with the back towards 

 the rectum. The urethra is then opened from behind forwards. Urine 

 at once escapes ; if need be, a tube is easily passed into the bladder. 



THE FEMALE URETHRA 



The female urethra opens into the vulva about an inch below the 

 clitoris. It is an inch and a-half in length, and descends close in 

 front of the anterior wall of the vagina. Its coats consist of vascular 

 and elastic tissue, and of an abundant lining of mucous membrane, 

 which is thrown into longitudinal folds. The epithelium is transitional 

 and squamous. Passing through the somewhat indefinite triangular 

 ligament, the urethra is surrounded with the representative of a com- 

 pressor urethrae. It is extremely dilatable, and may, by careful 

 management, admit the index-finger for exploration of the bladder. 

 Even in the child a lithotrite may be safely passed along it, or a good- 

 sized stone removed through it, without more serious consequence 

 than a temporary paralysis (v. p. 389.) 



To pass the female catheter without exposure of the parts, 

 cannot be done without practice ; the operation should be learnt upon 

 the cadaver. Descending from the anterior fourchette, the tip of the 

 left index-finger just touches the clitoris ; at about an inch further 

 down is a flat papillary enlargement, in the centre of which is the 

 urethral opening. The catheter is then run along the pulp of the 



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