Urethra

“ Aged individuals of the male sex, in whom the prostate is prone to enlargement, and the urethra to organic stricture, are hence more subject to the formation of stone in the bladder, than youths, in whom these causes of obstruction are less frequent, or than females of any age, in whom the prostate is absent, and the urethra simple, short, readily dilatable, and seldom or never strictured. ”

“ Besides this effect of the lateral parts swelling, a small portion of it, which lies behind the very beginning of the urethra swells forward like a point, as it were, into the bladder; acting like a valve to the mouth of the urethra, which can be seen, even when the swelling is not considerable, by looking on the mouth of the urethra, from the cavity of the bladder, in the dead body. It sometimes increases so much, as to form a tumour projecting into the cavity of the bladder some inches. ”

“ A considerable amount of œdema and ecchymosis of the scrotum developed, but no extravasation of urine. A catheter was kept in the urethra for some days, and the opening eventually closed by granulation.
I only once saw a patient with an injury to the deep urethra; in this case concurrent injury to other pelvic organs led to death on the third day. As a good many of the patients with pelvic wounds died rapidly, the accident may have been more common than my experience would suggest. ”

“ Hence we can readily see that not only by reflex nervous irritation are those parts debilitated, through the contraction of the urethra, but the affection is apt to extend by continuity of the mucous membrane, and thus become more and more manifest, through symptoms of disease of the testicles, prostate gland and seminal vesicles, and these disorders become more and more seated the longer the morbid condition of the urethra is allowed to run on, until there may be an entire loss of the sexual functions, occurring at an age when there should be present the most vigorous manhood. ”

“ The daily passage of the sound is objectionable, even if it gives relief at first, for it is liable to kindle a slow inflammation in a urethra unaccustomed to its use. When a sound is inserted it should not be left an instant in the bladder, but should be gently withdrawn as soon as it has been fully inserted. If left in the urethra, it does no good, and may act upon the cut-off group of muscles in the membranous urethra, causing them to contract spasmodically, as in the physiological performance of the coup-de-piston after urination. ”

“ By pressure made upon the urethra from above downward a purulent discharge from the ducts will be produced and can be seen escaping. The only effective treatment is to lay open the glands their whole length. They run upward in the posterior wall of the urethra, so that by passing a fine probe-pointed scissors they can be laid open on the vaginal surface. Care should be taken to prevent the incision from reuniting, and if the inflammation does not promptly subside applications should be made, as in the ordinary treatment of inflammation. ”

“ In the case of some parts of the body, disproportionate development of the part may not give rise to anything further than unsightliness; but when we find the small size of the urethra retarding the free passage of the urine, then we may expect, if this condition is long continued, to find more or less irritation of the urethra and, perhaps, of the bladder, also. ”

“ The urethra maintains these properties in disease as well as in health, and upon the strength of this fact, is the practice of dilatation in the cure of permanent stricture founded, permanent stricture, it will be recollected, is a positive narrowing of the urethric canal; and as it is the nature of all organic diseases to progress, unless prevented by art, it needs no stronger argument than necessity to show how imperative it is to set about their removal. ”

“ Dilatation of the whole urethra is not so common as dilatation of a portion of it. Even when the whole canal is larger than it should be, it is not, as a rule, uniformly so. In general, the urethral walls and the urethro-vaginal septum are usually enlarged, relaxed, and flabby. After a considerable time they may become indurated by infiltration or hyperplasia of the connective tissue. The mucous membrane is usually soft and loosely adherent to the subjacent tissues. ”

“ The procedure gives temporary relief, but then the urethra still remains to be put into a proper condition; a man cannot always void his urine and excrement through one common cloaca. If the urethra be cleared, the recto-vesical aperture may soon close. After the bladder is relieved, the urethra may become quieter, and admit of an instrument being more easily passed; but it is of very great consequence to effect the introduction of a catheter at the first. ”

“ The portion of the urethra surrounded by the prostate can alone be obstructed by this body when it has become irregularly enlarged, while the spasmodic stricture can only happen to the membranous portion of the urethra, and to an inch or two of the canal anterior to the bulb, these being the parts which are embraced by muscular structures. The urethra itself not being muscular, cannot give rise to the spasmodic form of stricture. ”

“ Imperfect closure is more frequent in males than in females, because of the great length and small caliber of the male urethra and its consequent tendency to obstruction. In the female there may be a discharge of a few drops only at a time, while in the male the urine will be expelled in strong jets coincidently with the contractions of the bladder and walls of the abdomen. ”

“ It may arise from relaxation and turgescence of the parietes, or from effusion of lymph either under the lining membrane, or on its surface. Spasmodic stricture has been spoken of by some writers, but is most probably an imaginary disease. An irritable urethra, in which organic disease does not exist to any great extent, may contract at some point, diminish the stream of urine, and prevent the introduction of instruments, or retain them by closing firmly round, and in such circumstances the obstruction does probably depend on spasm of the muscular fibres surrounding the urethra ”

“ Youatt advised laying open the sheath so as to reach and extend the penis, and others have advocated opening the urethra in the space between the thighs or just beneath the anus, but such formidable operations are beyond the stock owner. The incision of the narrow urethra through the great thickness of muscular and erectile bleeding tissue just beneath the anus is especially an operation of extreme delicacy and difficulty. Drawing the liquid through the tube of an aspirator is another possible resort for the professional man. ”

“ Stricture of the urethra, prostatic disease, and gravel, or stone in the bladder, are all capable of producing obstruction to the free flow of the urine.
How Slight Ailments become Dangerous Diseases. As we have before stated, the mucous membrane lining the bladder is reflected upwards into the ureters, lining these canals. By reason of this continuity of mucous surfaces, patients suffering from urethral, prostatic, and bladder affections, often die from disease of the kidneys. ”

“ On the other hand, in paralysis and atrophy the stream is slow and without force—so much so that voluntary effort or the pressure of the hand on the abdomen is sometimes necessary to empty the bladder. This is especially so when the catheter is used while the patient is in the recumbent position. Finally, the diagnosis may be confirmed by testing the dilatability of the urethra. This can be done by passing a dilator along the urethra and gently testing the resistance of the walls of the canal. There is a slight yielding at all points except at the stricture, where a decided resistance is met. ”

“ The sensations or sensitive motions of the glans penis, and of the sphincter of the bladder, have been accustomed to exist together during the discharge of the urine; and hence the two ends of the urethra sympathize by association. When there is a stone at the neck of the bladder, which is not so large or rough as to inflame the part, the sphincter of the bladder becomes stimulated into pain ”

“ Temporary relief is experienced when the urethra gives way by ulceration, and the urine becomes extravasated into the cellular texture; the patient gets up, and, if in the dark, thinks that the stricture has yielded, and that he is passing urine naturally. But soon he feels a glowing heat in the perineum; the parts swell and become livid; violent constitutional symptoms come on, the discoloration advances, the integuments slough, ill formed matter is discharged, and disorganised cellular tissue mixed with putrid sanies is exposed. ”

“ The operator, standing on the patient’s left side, is now to raise the penis so as to render the urethra, 8, 8, 8, as straight as possible between the meatus, a, and the bulb, 7. The instrument (the concavity of its curve being turned to the left groin) is now to be inserted into the meatus, and while being gently impelled through the canal, the urethra is to be drawn forwards, by the left hand, over the instrument. By stretching the urethra, we render its sides sufficiently tense for facilitating the passage of the instrument, and the orifices of the lacunae become closed. ”

“ Bigelow reports the case of a woman who habitually introduced hair-pins and common pins into her bladder. She acquired this mania after an attempt at dilatation of the urethra in the relief of an obstinate case of strangury. Rode reports the case of a woman who had introduced a hog's penis into her urethra. It was removed by an incision into this canal, but the patient died in five days of septicemia. There is a curious case quoted of a young domestic of fourteen who was first seen suffering with pain in the sides of the genital organs, retention of urine, and violent tenesmus. ”

“ The bougies which I employ are constructed upon an improved plan to those in general use: the elastic, as they are termed, although assisted in their attempted passage to the bladder by the smooth and well-lubricated sides of the urethra, have a constant tendency to straighten, and consequently are liable to hitch in all the folds they may encounter, which, in relaxed habits, are very numerous in the membranous portion of the urethra. ”

“ In fact, the symptoms here given may all be produced by other pathological conditions, and consequently cannot alone guide to a correct diagnosis. The true character of the trouble can only be discovered by physical exploration.
DIAGNOSIS.—A digital examination by the vagina will detect the increased space occupied by the urethra. The canal encroaches upon the anterior vaginal wall, and feels like a ridge extending from the meatus to the neck of the bladder. This elevation or thickening of the urethra is elastic and compressible in recent cases ”

“ A case of double urethra in a man of twenty-five living in Styria who was under treatment for gonorrhea is described, the supernumerary urethra opening above the natural one and receiving a sound to the depth of 17 cm. There was purulent gonorrhea in both urethrae. Vesalius has an account of a double urethral aperture, one of which was supposed to give spermatic fluid and the other urine. Borellus, Testa, and Cruveilhier have reported similar instances. Instances of double penis have been discussed under the head of diphallic terata, page 194. ”

“ Fig. 4, Plate 58, represents the neck of the bladder and neighbouring part of the urethra of an ox, in which a polypous growth is seen attached by a long pedicle to the veru montanum and blocking up the neck of the bladder. Small irregular tubercles of organized lymph, and tumours formed by the lacunae distended by their own secretion, their orifices being closed by inflammation, are also found to obstruct the urethral canal. ”

“ Urethra.—The urethra performs the important mission of emptying the bladder, and is rendered very much larger by the passion, and the semen is propelled along through it by little layers of muscles on each side meeting above and below. It is this canal that is inflamed by the disease known as gonorrhoea.
[pg 235, ToC]
5. Prostate Gland.—The prostate gland is located just before the bladder. It swells in men who have previously overtaxed it, thus preventing all sexual intercourse, and becomes very troublesome to void urine. This is a very common trouble in old age. ”

“ The discharge from the urethra is greatly increased in quantity, showing the formation and bursting of an abscess of the prostrate gland into it.
The bladder is much thickened and diminished in size, and acutely or chronically inflamed. The desire to make water is continual, allowing hardly a moment of rest; and the patient, in the agony of despair, prays to be relieved from his sufferings.
Soon succeeding the irritation of the prostate, the testicles become involved, the disease being propagated by means of their ducts, which open into the urethra. ”

“ On June 18th, 1847, I exhibited, in University College 359Hospital, ether to a man, aged forty-two, with stricture of the urethra, caused by an accident. He passed his urine only in drops, and the attempts to pass a catheter had all failed. It was Mr. Liston’s intention to divide the urethra in the perinæum, but when the patient was placed fully under the influence of ether to the fourth degree of narcotism, a catheter (No. 1) passed into the bladder, and the operation was not required. ”