SUB-URETHRAL ABSCESS.
I desire under this subject to call attention to a curious affection of the urethro-vaginal septum, whose etiology is still obscure.
An abscess is found in rare cases distending the urethro-vaginal septum and projecting clown into the lumen of the vagina. It varies from the size of a small nut up to that a hen's egg. It is well defined, rounded, and extremely tender to the touch, and is often associated with painful rnicturition and the intermittent discharge of pus from the urethra. Coitus is extremely painful. The examination is best made under amesthesia, as the patient shrinks from the slightest touch. On pressing on the tumor pus escapes from the urethra and the tumor sensibly diminishes in size.
In a case of my own, described in the Johns Hopkins Hospital Bulletin, April, 1894, the patient was colored, 31 years of age, married, and child less. Sexual relation was painful from the first. For four years she had noticed a small lump in the vagi na, and an occasional dis charge of pus from the urethra during the inter vals between mictnrition. An ovoid mass, 3 by 2,1 cm. in size, was found under the urethra (see Fig. 87), pres sure upon which caused the escape of pus from the ure thral orifice. The urethro
scope showed a little de pression in the urethral floor a short distance from the internal orifice. A probe was inserted at this point, and on making pres sure on the vaginal side, pus was seen oozing through the opening. The relations of the parts are shown in the diagram (Fig. 88).
Various explanations have been offered as to the cause of this trouble which it will not be necessary to discuss here. I believe the probabil ity is that the abscess is clue to the infection of Skene's ducts, with closure of the ori fice and subsequent perfora tion of the floor of the urethra, as in the formation of an ab scess of Bartholini's gland.
The treatment is either by incision extending through out the whole extent of the sac, packing with gauze, and keeping the incision open until it closes by granulation; or by excision removing an elliptical piece of the vagi nal mucosa and carefully dissecting out the whole cyst wall down to the urethra, which is left intact, followed by immediate closure of the wound by silkworm-gut sutures.