RETENTION OF URINE - FOLLICULITIS AND PERI-URETHRAL PHLEGMON.
The conditions producing the retention are to be considered care fully in deciding upon its treatment. In a given case occurring in the course of a gonorrhoea, we must remember that the factors in its production are several, viz., (1) inflammatory swelling of the mucous membrane and consequent diminution of the calibre of the urethral tube; (2) irritation produced by the acid urine ; (3) prostatic con gestion; (4) muscular spasm. In patients who have suffered from previous attacks there may be a stricture, to which the foregoing factors are superadded as plus conditions. A prostatic abscess may be present, causing retention by simple pressure; this is immediately relievable by incision.
The indications for treatment are plain: sedatives, derivatives, antispasmodics, alkaline diluents, and rest comprising the main features.
A full dose of morphine hypodermically or per rectum, and a hot sitz-bath, to be repeated as occasion demands, are of immediate necessity. Ice in the rectum sometimes assists in relieving local congestion. Leeches to the perineum and anus are often very valu able. Hot drinks of demulcent infusions are of service as adjuvants.
If abscess exists about the prostate, an incision is necessary.
An injection of cocainized oil into the urethra may be of service. The dread of painful micturition and the reflex effect of the irritating urine is often an important factor in the etiology of retention; the cocaine may relieve this. The catheter should be used only as a last resort. It is far better, in the author's opinion, to tap above the pubes than to use the catheter, other things being equal. If for any reason it is decided to use the catheter, an anaesthetic should gener ally be given; cocaine, however, may be used. The greatest gentle ness should be exhibited in the passage of the instrument. Before passing it, the urethra should be thoroughly and deeply flushed with a mild, warm antiseptic solution. By these means we may be able to avoid infecting the deep urethra and bladder. In the author's experience, instrumental interference has rarely been necessary.