The most common forms are those depend ing on stricture ; they are preceded by ulcer ation or sloughing, which generally takes place behind the seat of stricture. Syme thinks that ulceration of the urethra is se condary to the formation of matter, which is external to the urethra, and precedes the ul ceration. Abscesses now and then form in the vicinity of the urethra without any direct, or indirect communication with the canal ; this happens occasionally in cachectic states of the constitution, in which abscesses are not unfrequent in the vicinity of other mucous out lets, as the rectum. When these are opened, the matter is disgustingly foetid, and is strongly impregnated with an urinary odour, although no urine has become mixed with it, no breach having occurred in the urethral membrane.
One of the most common forms of abscesses connected with the urethra arises from in flammation of the lacuna during a severe attack of gonorrhoea. Under these circum stances the orifice of the lacuna, the subject of the disease, probably becomes closed by adhesive inflammation, a small, round, indo lent tumour is formed in the direction of the spongy body, or in the perinmum. Ulcera tion or bursting into the urethral canal often occurs, and the urine escapes into the sac, causing increase of inflammation ; and now distinct suppuration having taken place, fluctuation becomes evident, and either the matter escapes externally by ulceration, or the surgeon is induced to puncture it with a lancet.
states that he has rarely examined the urethra of tuberculous subjects. Rayer, however, quotes two cases, one of which he witnessed himself, and the other was communicated to him by Vernois. The former occurred in a man thirty-six years of age, who had tubercles in his kidneys, testicles, and prostate; the latter in a boy, aged twelve, with tubercles in the kidneys and on the sur face of the peritoneum ; in this case the whole urethra was apparently affected ; in the other, only two inches and four lines of the vesical end were diseased.
Ricord presented to the Academy of Me dicine* a curious specimen of an urethra completely studded with miliary tubercles. It was removed from a man who had undergone the operation of castration for tubercular deposit in the testicle some years previously. The prostate contained a tubercular excava tion.
The urethra is sometimes traversed by cords, in some respects resembling at first sight the cord Villisii of the longitudinal sinus. I presume they are formed by organi sation of effused lymph. There is a curious specimen of this disease in the Museum of St.
Bartholomew's Hospital, marked in the Cata logue 30. 37. The patient from whom the preparation was taken had been frequently the subject of catheterization. The disease is exceedingly rare.
Under this head are enumerated all contractions of the urethra depending on alteration of the tissue of the canal itself, or the parts immediately surrounding it. Stric tures are commonly arranged under three heads—spasmodic, permanent or organic, and inflammatory or irritable stricture.
A spasmodic stricture may be defined to be a temporary diminution in the diameter of the urethra, sometimes to such an extent as to effect its complete closure, from spasm of the muscles surrounding it. The term can only, with strict propriety, be applied to a tem porary contraction of the muscles investing the membranous portion, as no action of the acceleratores urinm is equal to the complete closure of the spongy part. The common seat of spasmodic stricture is therefore the membranous part.
Spasm of the urethra arises from various causes, as exposure to cold, indulgence in wine and venery, and gonorrhoeal inflamma tion. So also, certain medicines, as cantha rides, when taken into the stomach, or ap plied endermically, may induce a similar con dition.
Although genuine spasm is confined to the membranous part, yet the remainder of the urethra is liable to temporary contraction f'rom general irritation of the mucous surface, as where the urine is loaded with lithates, and hence becomes exceedingly irritating. Under these circumstances the stream of urine is diminished, and the urethra resists the introduction of the catheter. This con dition probably depends on irritability of those fibres, be they muscular or not, which enter so largely into the structure of the outer layer of the urethra.
Spasmodic stricture may he recognised in the following manner : a patient observes a sensible diminution in the stream of water, aggravated by drinking and free living. After unusual indulgence in wine or venery, he finds suddenly that he is unable to pass a drop of water ; the surgeon, on attempting to introduce an elastic catheter, which is the best adapted for the case, finds the progress of the instrument impeded at the membranous part of the urethra ; by gentle pressure, how ever, the spasm yields, and the instrument enters the bladder suddenly, and all sense of contraction disappears. On using the instru ment on the following day, he finds that it passes with perfect freedom.