PATHOLOGY..- Under this head are in cluded, first, all deviations from the normal condition arising from arrest of development ; secondly, all changes in the direction and con dition of the urethra depending on disease. The first are necessarily congenital, the second acquired.
Congenital malformations. — The urethra is seldom altogether absent: it is, however, wanting in cases of decided cloacal formation, and in the female, where there is partial deficiency of the bladder (ectrophy) ; but in those cases in which the urachus remains patent, and where the urine is discharged by this canal, the urethra is always met with.
The urethra sometimes runs along the dorsum of the penis in the form of a broad groove. This malformation is termed epispadias, from the Greek word i7riarciw, in contradis tinction to hypospadias, from ilirroo-rdis, sub traho, as in the latter malformation the penis is drawn down.
Epispadias is frequently complicated with ectrophy of the bladder, but often exists in dependent of this congenital malformation.
In either case there is generally consider able diastasis of the symphyses pubis, the hones being united together by a long inter vening ligamentous structure. In epispadias there is also a deficiency in the superior part of the prostate gland, the lobes of which are seen only below, and the veru montanum is found in its usual situation ; the prostate is generally smaller than common ; the penis also is but imperfectly developed. The urethra itself forms a mere superficial channel along the dorsum penis; it is copiously supplied with large lacuna, the corpus spongiosum is want ing above, and the glans is cleft; the prepuce ceases at the corona glandis.
In a case which I recently examined, the bladder was small, and, as if to supply the deficiency in the muscular apparatus of the membranous part of the urethra, which was necessarily wanting, the acceleratores urinm were immensely developed ; their superior attachment was of course deficient.
Hypospadias implies that form of malforma tion in which the urethra runs in a groove beneath the penis ; it is subject to considerable variation. The most common variety is that where the urethra forms a simple groove, and the penis is bent downwards, the prepuce being wanting. If this groove be continued down
deeply to the perinmum, between the two sides of a fissured scrotum, the whole genital system takes on snore or less of the female character, and hence has arisen the false notion of the subject of hermaphroditism.
There are many modifications of this mal formation. Otto* mentions one case where the penis was cleft, and the vestige of the divided urethra was easily recognised, a fossa navicularis being distinguishable on either side, as well as the termination of an ejaculatory duct. The prostate was wanting. Some times the urethra is perfect in the glans, and throughout the remainder of its course it is open beneath the penis.
The urethra sometimes terminates before it reaches its usual destination. Thus it opens into the rectum, or into the perimeum ; in other cases it goes no further than the root of the scrotum ; sometimes it ends at the corona glandis, or it may end at any distance between this body and the bulb. Occasion ally the opening is altogether wanting urethra), or it is covered by a delicate fold of skin. When it terminates in any of these unusual situations, the opening is very small, sometimes so small as not to admit the in troduction of a bristle. Now and then we meet with a rudimentary meatus in the usual situation, terminating in a cul-de-sac, and beneath this a small urethral orifice. When the urethra ends at the corona glandis, the prepuce is imperfect ; it is thrown into a fold resembling the hood of a monk, and is hence denominated the monk's hood prepuce, and the glans is uncovered.
Deviations in diameter, although occasion ally congenital, are generally the result of disease. A preternaturally contracted state of the urethra is sometimes found at birth. This may happen at the orifice as before men tioned, or in other parts of the canal. Under this condition, the bladder, ureters, and pelves of the kidneys are sometimes dilated, as in ordinary cases of stricture. f Congenital stric ture of the urethra is nevertheless exceedingly rare.