NEW GROWTHS OF THE FEMALE URETHRA.
The portion of the urethra which is more liable to be affected by new growths is the external meatus.
At this point we may meet with condylomata, vascular outgrowths, called urethral caruncle, mucous polyps, carcinoma, and sarcoma.
Condyloma.—Condylomata are little warty growths generally found in association with similar disease of other parts of the external gen itals, of a pale color, more or less pedunculatecl, and not sensitive or bleeding readily. Their microscopic characteristics are those of the condylomata elsewhere. They may be snipped off with scissors and the base touched with galvano-cautery to check hemorrhage.
Caruncles.—Urethral caruncle is a disease of the external meatus involving one or both lips ; it appears as a deep raspberry red tumor, projecting well beyond the lumen of the urethra, exquisitely sensi tive, and bleeding readily upon touch. These tumors are made up of connective tissue and an extensive network of blood-vessels. Their sensitiveness is often so extreme as to cause the patient the greatest agony in passing urine. It is not yet precisely known to what the sensitiveness is due, whether to unusual nerve supply, or to the baring of the nerve endings by the destruction of the epithelium on the surface.
The treatment of this affection is by excision of the tumor at its base, under cocaine anfesthesia, bringing together the edges of the wound by the finest silk suture. The galvano-cautery has been used, but is unsafe where the disease is extensive, as it is liable to be fol lowed by a cicatricial contraction of the urethral orifice.
Polyps of the Ureara.—Delfosse (Revue d' Obstetrique et de Gynecolo gic, 1892) reports a case of a patient twenty-five years of age who suf fered violent pains in urinating. On inspection he found numerous little tumors at the urethral orifice, and with the urethroscope dis covered that the whole urethra was covered with small polyps. He re
moved these with the curette, which occasioned but little loss of blood. The pain had disappeared by the fourth day, and four months later there was no return of the disease.
Concretions have been observed in the urethral glands of the fe male, analogous to the prostatic concretions in the male.
Carcinoma. —Carcinomatous disease may affect the urethra by ex tension from the surrounding parts, such as the cervix or the exter nal genitals. Primary carcinoma of the urethra is extremely rare. Cases of cancer affecting the vestibule and so rapidly involving the urethra have been described. Patients affected with carcinoma present no specially characteristic symptoms. The urethral orifice is found to be the seat of a tumor which appears red, bleeds easily, erodes and breaks down in places, and is not tender to the touch. The proliferation of tissue and the breaking-down may be so marked as to leave no doubt at any time as to diagnosis.
The treatment of the disease will depend upon the stage at which it has been discovered. If a patient has applied early for treatment, while the disease is still limited to the neighborhood of the external urethral orifice, it may be excised, a wide margin of tissue being removed on all sides. When the affection has travelled up the ure thra to the bladder, and there is some surrounding infiltration, ope rative procedures will be of no benefit.
Sarcoma.—Sarcoma of the urethra has been described by Beigel. The tumor was the size of a walnut, situated on the margin of the urethral orifice. It contained numerous spaces with colloid material. The treatment was by extirpation.