STRICTURE is a term employed in surgery to denote an unnatural contraction, either congenital or acquired, of a mucous canal, such as the uretha, oesophagus, or intestine. When, however, the affected part is not mentioned, and a person is stated to suffer from stricture, it is always the urethral canal that is referred to. Contraction of this mild may be either permanent or transitory; the iormer is due to a thickening of the walls of the urethra, in consequence of organic deposit, and is hence termed organic stricture; while the latter may be due either to local inflammation or congestion, or to abnormal muscular action: the first of these varieties may be termed inflammatory or congestive stricture; and the second. spasmodic stricture. The last-named form seldom exists except as a complication of the other kinds of stricture. There are two principal causes of organic stricture—the first being inflammation of the canal, and the second injury by violence. Inflammation is by the most common cause, and gonorrhoea is the com mon agent by which it is excited. Not unfrequently, stimulating injections thrown into the urethra, with the view of checking the gonorrhoeal discharge, excite an inflam matory action, which gives rise to stricture. Fortunately, it is only in exceptional cases that a stricture results from inflammation of the urethra, the inflammation, in the great majority of cases, terminating by resolution, and leaving the canal as healthy as before the attack. It is when the complaint assumes a chronic character that it most com monly lays the foundation of stricture. Stricture from the second cause arises from such cases as falling across spars, scaffolding, ladders, etc., or on sonic sharp object which punctures the perineum, as from earthenware vessels which break under the sitter.
The earlier symptoms of stricture are a slight urethral discharge and pain in the canal, behind the seat of the stricture, at the time of micturition. The stream of urine does not pass is its ordinary form, but is flattened or twisted; and as the disease advances. it becomes smaller, and ultimately the fluid may only be discharged in drops.
The straining efforts to discharge urine often induce tenesmus (q.v.).
As the case advances, the urine becomes alkaline and ropy. and deposits a precipitate when allowed to stand: and attacks of complete retention (q.v.) occur with increasing frequency. But these symptoms are not in themselves sufficient to establish the presence of stricture. It is necessary to examine the urethral canal with a catheter (q.v.) or bangle (q.v.), to ascertain whether an organic obstruction exists, whether one or more strictures are present (as many as eight have been recorded. although four are rare: and one is the most common number), and their caliber. The treatment of organic stricture is too purely surgical lobe discussed in these pages: it is sufficient to state that its object is twofold, viz., first, to restore the natural caliber of the canal, so far as this can be safely effected"; and, secondly, to maintain this patency. after it has been established.
Spasmodic stricture may occur from any of the following causes: The presence of organic stricture or of inflammation of the mucous membrane; from an acrid condition of the urine; from the administration of cantharides, turpentine, etc.; and from the volunt:ry retention of urine for too long a time. The treatment consists in the removal of the causes as far as possible, and the hot bath. The inhalation of chloroform some times gives immediate relief; and several eases are recorded in which, when the spasm occurred periodically, it was cured by quinine. Inflammatory or congestive stricture commonly arises when a recent purulent discharge from the urethra has been checked by external cold or wet. The patient complains of heat, fullness, and soreness in the perineum; the passage of the mine is extremely painful, the stream being small, and ceasing before the bladder empties. The treatment is much the same as that for reten tion of urine (q.v.). •