SYMPTOMS - STRICTURE - ORGANIC STRICTURE.
One of the earliest symptoms is disturbance of the function of urination. This consists in frequency of micturition due to two causes, viz., (1) reflex irritation of the prostatic urethra or of the vesical neck, and (2) direct irritation from germs and their products developing behind the obstruction. Some patients first consult the surgeon regarding increased frequency of micturition occurring only at night, having been troubled in this way perhaps for many years with out the development of any other symptoms. Strictures at or near the meatus are especially liable to produce reflex irritation of the vesical neck. Dribbling of urine after micturition is an early symp tom. This is due to interference with the continuous wave of con traction of the accelerator urinac muscle, the function of which is to expel the last few drops of urine. Imperfect ejaculation of semen results from a similar condition. The stream of urine may be forked or twisted according to the form of the stricture. There may be several streams simultaneously expelled from the meatus and tak ing unusual and inconvenient directions. The stream may present a fan-shape or resemble very much a stream of water thrown from a garden sprinkler. As the case progresses the patient notices that it is necessary to bring into play the auxiliary action of the abdominal muscles in micturition. The stream of water finally becomes very small and complete retention may at auy time occur, especially if the patient be exposed to causes of spasm or congestion of the affected part. Neurotic symptoms are sometimes present. Neuralgic pains
in various situations, especially in the vicinity of the genito-urinary organs, are quite frequent. Pain in the back, genito-crural neural gia, pain in the testes and perineum, and sometimes pain reflected to the anus and rectum are observed. Profound mental depression and pseudo-impotence are occasionally met with. General malnutrition, hypochondria, and malaise are often noted. A certain degree of general toxaemia is sometimes responsible for the various general symptoms present in stricture. This may be of a distinctly imemic type, or clue to the absorption of toxins from the site of the lesion or such portions of the genito-urinary tract as may happen to be the site of bacterial action. One of the most characteristic symptoms of stricture is a gleety discharge. While this discharge is by no means pathognomonic of stricture, it is safe to assert that it is in dicative of that condition in by far the larger number of cases. Gleet should always be regarded as symptomatic and its causes sought for. In stricture, the gleet may be the perpetuation of a more or less recent gonorrhoea, or it may be of recent development and clue to the gradual encroachment of the adventitious tissue upon the urethral lumen with resulting decomposition of residual urine and the devel opment of chronic inflammation. Hemorrhage during the sexual act or during micturitiou is an occasional symptom.