SPASMODIC STRICTURE.
Spasmodic stricture—or, as it may justly be called, pseudo-stric ture—may be defined as a diminution of the calibre of the urethra, due to spasmodic contraction of the muscular fibres in and about the walls of the canal. This contraction may produce complete retention as a result of such exciting causes as acid urine, intemperance, or sexual indulgence.
Spasmodic stricture is merely au intensification of the physio logical function of the cut-off, accelerator urines, and compressor ure thrn muscles, in which, from various sources of irritation, the muscu lar fibres are spasmodically contracted and the volitional power of the patient over the act of urination is for the time being held in abeyance.
The site of spasmodic stricture varies. There are almost always two points of spasmodic contraction: (a) At the point of irritation, and (b) in the musculo-membranous urethra.
1. When a foreign body is introduced into the canal, the urethra resents the liberty at any point of irritation, and there occurs simul taneously with a slight contraction at the point irritated, a reflex spasm of the cut-off and urethral muscles. The same is often true in cases of organic stricture in the penile portion of the urethra or at the meatus. This is an important practical point, for it has been established that, simultaneously with the removal of an anterior point of obstruction and irritation, a supposed deep organic stricture often disappears.
2. The entire canal may be spasmodically•contracted and resent the introduction and withdrawal of instruments.
3. The musculo-membranous region may alone be involved. This happens in cases in which an organic lesion 'exists in the deep ure thra and in those in which spasm is due to reflex causes.
The causes of spasmodic stricture may be classified as : 1. Predisposing Causes.—(a) General hypermsthesia; (b) local hypersthesia. Both of these causes are modified by a nervous temperament, debilitated and cachectic states of the system, the rheumatic and gouty diatheses, intemperance, high living, faulty sexual hygiene, etc. (c) Acute or chronic disease of the urinary organs. This is the most frequent predisposing cause, and it is rarely indeed that a case of spasmodic stricture is met with in which a more or less damaged state of the canal does not exist. So uni formly is it present, that it is always to be suspected until organic disease has been excluded by exploration. Congested and fungating patches, erosions of the mucous membrane, acute and chronic urethri tis, and organic stricture of whatever degree, constantly predispose to spasmodic contraction, both at the point of irritation and at the cut off muscle; such predisposing causes are always effective in its pro duction during the passage of an instrument. A congenital narrow
ing of the meatus or other parts of the canal may give rise to reflex spasm of the deep urethral muscles in any case in which an instru ment is passed, of a sufficient size to produce stretching of the sensi tive tissues at the point of contraction. As already noted, when in struments are introduced under the pathological conditions alluded to, there is a spasm at the site of the lesion and another deep down in the canal.
2. Exciting Causes.-1, Passage of instruments; 2, sexual excite ment or excess ; 3, injury to the canal—chemical or traumatic; 4, a debauch; 5, cold-taking; 6, foreign bodies ; 7, drugs, such as can tharides and turpentine; 8, reflex irritation; 9, malaria (?) ; 10, men tal emotions.
A survey of the various exciting causes of spasmodic stricture is sufficient to indicate the fact that in nearly all instances the element of spasm is associated with congestion and inflammation—conditions which such special causes are most apt to excite. Spasm due to drugs is usually associated with considerable inflammation and at tended by frequent and painful micturition (strangury), perhaps associated with urethral hemorrhage. The most frequent exciting causes are intemperance, exposure to cold and wet, and sexual excess. Highly acid urine in gouty patients is said to act as an exciting cause per se in some cases, but it is in the highest degree doubtful if such a condition of the urine could bring about obstructive spasm in a perfectly healthy canal. It is, however, an important element in spasm produced by excesses of various kinds and cold-taking. In strumentation of a sensitive canal, especially if organic disease exists, is likely to develop spasmodic stricture which may last for some days or weeks.
It was shown some years ago by Dr. Fessenden Otis that spas modic stricture frequently becomes chronic. This condition of chronic spasm he termed urethrismus. It is usually due, according to Otis, to sources of reflex irritation in the urethra, or in the vicinity of the scrotum and testicles. It may, however, be due to highly acid urine and is an occasional concomitant of the gouty diathesis.