MALFORMATIONS OF THE URETHRA Commonest of all malformations of the urethra is a marked lat eral displacement or obliquity of the external orifice. When the ure thral orifice appears distinctly on one side, there is apt to be a shal low vertical fissure at a corresponding point on the opposite side, with ft ridge between the two, appearing to indicate an early embry onic double, urethra.
Other malformations are due to failure in the development of some portion of the urethral wall in embryonic life. These are called, accordingly as the defective part is the external or internal portion of the urethra, defectus urethrce externus and defectus urethrce interims. If the whole urethra is wanting, the anomaly is described as defectus urethrce totalis. If a portion of the anterior inferior wall is absent, the condition is one of hypospadias.
These anomalies of the urethra are as a rule associated with other anomalies of the external and internal genital organs.
Defectus Urethrce Totalis.—In total absence of the urethra its rudiments are invisible externally, and the opening for the discharge of the urine exists in the form of a slit in the base of the bladder. In a case of Langenbeck's, cited by Winckel, a girl of nineteen had an imperforate hymen, the urethra was absent, and vagina and bladder formed a common canal.
Atresia of the Urethra.—In this case, the urethra is open as far as the bladder, which is closed and together with the ureters dilated. Schatz has reported a case in which the urethra ended in a cul-de-sac 5 mm. long. The rest of the urinary apparatus and the internal
genitals were completely divided into right and left, and the bladders opened into the vagina through congenital vesico-vaginal fistulee.
Hypospadias.—In hypospadias, the anterior and some of the lateral urethral walls are present and indicated by a furrow, while the inferior wall is absent from the external orifice to a greater or less extent backward; the urethra thus opens well within the vagina. In one instance of this kind, in the case of a woman forty-six years old, the common urinary and vaginal orifice lay small and contracted underneath the symphysis. A half an inch farther in, it was divided into three passages, the anterior being the urethra, which was an inch long, and the posterior a double vagina nearly three inches long.
Many of these affections do not call for treatment, being either anomalies occasioning death in foetal life, as in the case of atresia, or associated with other serious malformations of the external genitals.
Mandl has reported a case (Wiener klinische Wochenschrift, 1891, page 515), of retention of urine for two days in a child, with a con genital atresia; the retention was accompanied by vomiting and con vulsions. The atresia was broken through by passing a sound into the bladder, and the symptoms were entirely relieved.