Urolith

“ When this has been made quite clear, then, before the animal urinates, one has to tie a ligature round his penis and then to squeeze the bladder all over; still nothing goes back through the ureters to the kidneys. Here, then, it becomes obvious that not only in a dead animal, but in one which is still living, the ureters are prevented from receiving back the urine from the bladder. These observations having been made, one now loosens the ligature from the animal’s penis and allows him to urinate, then again ligatures one of the ureters and leaves the other to discharge into the bladder. ”

“ Congestions, irritation and even inflammation of the Urinary Organs often occur in men, either alone or as a complication of Seminal Disease and Weakness. The Seminal Vesicles lie just behind the bladder, while the Seminal Ducts pass through the body of the Prostate Gland, and open into the urethra (or urine channel) upon its surface (see Fig. 5) . Hence, any inflammation or congestion of this large gland that lies at the root of the organ and neck of the bladder, is almost certain to produce Seminal Weakness, Losses and Impotence. ”

“ Symptoms. When the deposits are in the kidneys, there is pain in the back and loins, occasionally cutting and severe; sometimes it darts down the course of the ureter to the bladder, and extends even to the thighs. When the deposits are in the bladder, there is a frequent desire to urinate, with a bearing-down, straining pain; also a cutting or scratching sensation in the urethra during micturition. In the male, intense pain is often experienced at the end of the penis. ”

“ PASSAGE OF THE CATHETER AND URETHROTOMY IN THE RAM. Obstruction of the urethra in rams is more commonly caused by deposits of gravel than by single large calculi. It is generally found in highly-fed animals, in which gravel accumulates and becomes massed together at some point in the canal, often near the free extremity, where it forms a plug, causing complete retention of urine. In other cases this retention is due to a mass of sediment formed by vesical mucus and fine gravel which collects about the neck of the bladder. ”

“ If the stone is increasing in size, the quantity of sediment also increases, but if the stone is fully formed and confirmed, the amount of sediment decreases daily, and the urine becomes milky both in the kidneys and the bladder. A stone in the bladder occasions very similar symptoms, together with pain in the peritoneum and pubes, dysuria and strangury, and sometimes the appearance of blood and flocculi (trumbos?) in the urine. Patients suffering from vesical calculus are always constipated, and the dysuria may increase to the degree called furia, a condition not without some danger. ”

“ As secondary causes are those in which the inflammation starting in the uriniferous tubes extends down to and implicates the pelvis, and the still more frequent instances of extension of purulent infection upward from the ureter, bladder or prostate, so as to involve the pelvis. So in blocking of the urethra by strongylus, stricture, clot or calculus, and in spasm of the sphincter vesicæ, the delayed urine is liable to undergo fermentation with evolution of ammonia, and not only the bladder but the ureter and renal pelvis may suffer. ”

“ Each terminates considerably in front of the cloaca. Each ureter begins at the anterior end of the kidney, and thence proceeds on, its inner and dorsal border, receiving ducts from the interspaces of the numerous lobes. In the male each ureter opens upon a papilla, together with the vas deferens; in the female the ureter is joined by a blind canal, the vestige of the male duct. No snake has a urinary bladder. The urinary excretion is white, chalky, consisting mainly of uric acid in crystals, with very little fluid.
In the Lacertilia the kidneys are more posteriorly placed than in snakes. ”

“ 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. ”

“ The growths bleed very easily on manipulation, and are exquisitely sensitive. The urethral caruncle is the commonest neoplasm of the urethra.
Symptoms.—The most marked symptom of urethral caruncle is pain. Intense pain is experienced at micturition and upon contact with the clothing or other body. Sexual connection is sometimes rendered impossible.
There is usually more or less hemorrhage from the tumor, which may rarely be so profuse as to cause marked anemia. The general health suffers, and nervous symptoms, resulting from the pain and loss of sleep, are often present to a pronounced degree. ”

“ Patients usually understand, and medical men usually allow, a gleet to be a discharge from the urethra, which has existed some time, of a whitish color, unattended with pain, and that is not infectious, by which is meant is incapable of producing gonorrhœa. There are several kinds of morbid secretions, the successful treatment of which depends upon a knowledge of their differences. They may be divided into two principal orders—those secreted from the mucous surface of the urethra or bladder, and those which proceed from the various glands-leading into one or the other. ”

“ In 427 young women the orifices are found about 1⁄8 of an inch above the plane of the external meatus. If the external meatus be patulous, or if there be any prolapse or inflammation of the mucous membrane of the urethra, the orifices of Skene’s glands may be seen upon each side of the urethral orifice as soon as the labia are separated. In gonorrhea their position is often indicated by a small drop of pus exuding from the orifices. The upper ends of the glands may terminate in a number of divisions.
Urethritis.—Urethritis is much less frequent in women than in men. ”

“ It usually follows long, tedious deliveries, during which either the child's head or sometimes the forceps crushes the urethra against the unyielding pubic bones, giving rise to an acute urethritis, with swelling of the membrane and blocking up of the canal, causing retention. The primary injury is not done, as a rule, to the bladder in these cases, for if it were we should find the vesical neck the seat of sloughing of the mucous membrane; but, as a fact, this is the part (owing to its more loose connections with the underlying connective tissue) that most frequently escapes. ”

“ There may be imperforation or congenital occlusion of some portion of the urethra, causing enormous accumulation of urine in the bladder, but fortunately there is generally in such cases some anomalous opening of the urethra giving vent to the excretions. Tulpius mentions a case of deficient urethra. In the Ephemerides there is an account of a man who had a constant flow of semen from an abnormal opening in the abdomen. ”

“ There is a case described of a man who evidently suffered from a patent urachus, as the urine passed in jets as if controlled by a sphincter from his umbilicus. Littre mentions a patent urachus in a boy of eighteen. Congenital dilatation of the ureters is occasionally seen in the new-born. Shattuck describes a male fetus showing reptilian characters in the sexual ducts. There was ectopia vesicae and prolapse of the intestine at the umbilicus; the right kidney was elongated; the right vas deferens opened into the ureter. ”

“ 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 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. ”

“ Occasionally the urethra communicates with the rectum in consequence of ulceration, escape of urine into the cellular tissue, and formation of matter. The symptoms of stricture are often much relieved after the formation of fistulous openings; and the cure can then be much more easily accomplished than formerly, the passage being less irritable. When the fistula is free and open, allowing the urine to escape readily, the natural passage contracts, and will become almost entirely obliterated, unless means are taken to dilate it, and to diminish the unnatural opening. ”

“ In some old people, who have experienced a long retention of urine, the bladder never regains the power of completely emptying itself; and many who are beginning to be weak from age can make water a second time, a few minutes after they supposed they had emptied the bladder.
I have believed this pain to originate from sympathy with some distant part, as from ascarides in the rectum, or from piles in women; or from caruncles in the urethra about the caput gallinaginis in men ”

“ 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. ”

“ Ultzmann, of Vienna, in his work on the “Neuroses of the Genito-Urinary Organs,” gives the subject of enuresis considerable attention. It is not a work on diseases of children, but it, nevertheless, goes into the subject as if it were, and furnishes the profession with considerable information. He defines enuresis to be the passage of urine of a normal quality in a child who, with the exception of this involuntary urination, is healthy. In the first periods of life, a slight vesical or intestinal expulsive effort is sufficient to overcome the guarding sphincter muscles at their outlet ”

“ Simple urethritis is a mild and harmless catarrh of the urethra, which ordinarily clears up in from one to two weeks with a very simple treatment and even without treatment. Simple urethritis never leads to any deep or dangerous complications, never goes into the blood of the patient, and does not carry over affection to the wife and children. Unfortunately, from every hundred cases of urethritis, the majority of them, not less than ninety per cent, are real Gonorrhea, and the balance of ten cases are simple urethritis. ”

“ Belloc mentions a man whose urethra terminated at the base of the frenum who had four sons with the same deformity. Picardat mentions a father and son, both of whom had double urethral orifices, one above the other, from one of which issued urine and from the other semen—a fact that shows the possibility of inheritance of this malformation. Patients in whom the urethra opens at the root of the penis, the meatus being imperforate, are not necessarily impotent; as, for instance, Fournier knew of a man whose urethra opened posteriorly who was the father of four children. ”

“ The symptoms attendant on the collection and passing of sand, or gravel, as it is commonly termed, are,—pain in the loins; heat in making water; heat in the urethra occurring afterwards, continuing for some time, and usually at the orifice; frequent desire to empty the bladder; and an occasional mixture of blood with the urine. When aggregations of the deposit, forming concretions of some size, pass along the ureters, violent pain is felt in the course of these tubes. Often the patient complains of colicky pains all over the abdomen, and of sickness without vomiting. ”

“ 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 edge of the prepuce may be rendered tight by inflammation, swelling from effusion, or cicatrisation of sores; the tightness also attends irritability of the urethra, particularly in young subjects; often it is congenital. The affection is termed Phymosis when the prepuce occupies its natural relative situation, but cannot be drawn back so as to uncover the glans. The contraction exists in various degrees; sometimes the orifice is so tight that the flow of urine is obstructed, the præputial cavity becoming swelled and distended every time the patient attempts to make water. ”