TREATMENT - SPASMODIC STRICTURE.
Obviously, the first indication in the treatment of spasmodic stric ture is to remove all predisposing causes as far as possible. Such conditions as the gouty and rheumatic diatheses require correction. General nervous irritability and hyperdesthesia may require nervine tonics, or sedatives and anti-spasmodics, or both, according to the special indications present. The principles of genitourinary and sexual hygiene should be thoroughly impressed upon the mind of the patient. Once succeed in disabusing the patient's mind of the falla cious notion that his penis and testes constitute the axis around which his earthly existence revolves, and the treatment of the case is much simplified. Every possible source of local and reflex irritation must be removed. This necessarily involves in the majority of cases the cure of organic lesions of the urethra. The urine should be kept bland and non-irritating by dietetic measures and the administration of alkaline remedies. Careful study should be given in each case to the degree of tolerance of the urethra for instrumental manipulations. The amount of irritability of the urethra and the degree of spasm excited by the passage of instruments is a fair criterion of the fre quency with which they should be introduced in the treatment of organic stricture.
When retention comes on as a consequence of spasmodic stricture, an attempt should be made to relieve the condition. by derivation
—with a view of removing possible congestion—and by antispas modics. The passage of instruments should be avoided if possible, as tending to increase irritation and spasm. The full hot bath, and morphine by the mouth or hypodermically, should be depended upon as far as practicable. Very often the patient will succeed in passing urine while in the hot bath, which is .both derivative and antispasmodic. When these simpler measures fail, a small soft cathe ter should be carefully introduced, while the patient is in the bath if possible. If necessary, chloroform or ether may be given to the ex tent of full anaesthesia, for the purpose of relaxing the spasm. Whenever retention comes on in the course of organic stricture, it must be remembered that the accident is not due to the organic con traction per se, but to certain plus conditions, i.e., spasm, congestion, and oedema of tissue in varying proportions. The relief of the re tention depends upon the subtraction of these plus conditions from the primary obstructing factor of organic contraction. The treat ment of urethrismus is chiefly operative. After all sources of reflex irritation have been removed the urethrismus disappears.