CONGENITAL STRICTURE.
The congenital form of stricture is rare, if we exclude narrowing of the meatus. The existence of congenital stricture beyond a point one-fourth of an inch from the meatus is denied by the majority of surgical authorities. If, however, we take into consideration the occasional occurrence of congenital atresia of a part or the whole of the urethra, the possible occurrence of localized congenital narrowing of the canal seems logical. I have seen a number of cases of linear stricture of the pendulous portion of the canal which I believe to have been of congenital origin.
Congenital stricture of the meatus is a relative affair, inasmuch as it is not per se productive of discomfort, in by far the majority of cases. An individual with a meatus narrower than the average is not likely to be annoyed thereby, providing he never contracts gonorrhoea.
In order to determine the condition of the urethra, or to treat organic disease of the mucous membrane, the meatus must admit in struments of a size corresponding to the largest mean diameter of the canal.
Whenever, therefore, there exists a suspicion of urethral, pros tatic, or bladder disease and the meatus is contracted, it should be enlarged by incision to a size sufficient to admit an instrument which will thoroughly distend the canal.
In by no means exceptional instances a contracted meatus of con genital origin has been known to induce reflex neurotic disturbances in very much the same manner as does a pliimosed prepuce in some cases. Spasmodic stricture, irritability of the bladder with fre quent micturition, and perhaps other more suspicious symptoms of stone have been known to arise from this cause.