Stricture in its progress passes through various stages, from simple thickening to complete cartilaginous induration. The com plete cartilaginous conversion of stricture is more frequently found where the stricture is situated in the spongy portion.
The most intractable stricture is that which results from ulceration of the meatus ; it is frequently associated with adhesion of the prepuce to the glands; sometimes the stric tured part will not permit the passage of a bristle. For the cure of this disease incision is necessary.
Among the most common attendants on stricture of the urethra are hernial protrusions of the mucous membrane of the bladder, be tween the columns of the detrusor urine, in the form of sacculi. As a consequence of stricture of the urethra, may be mentioned rupture of the canal and of the bladder itself.
It is probable that these are preceded by interstitial absorption, and not unlikely by sloughing or ulceration. And the straining to overcome the impediment to the exit of the urine leads frequently to the formation of hernia at the groin, and has been attended with rupture of the rectus abdominis muscle.* - In old strictures the membrane of the urethra is usually hypertrophied, the orifices of the lacunm are enlarged, and the prostatic ducts considerably dilated. The prostate gland itself is frequently hypertrophied in consequence of the general irritation of the urethra.
False passages. — A false passage may he formed in any part of the canal, according to the seat of stricture ; there may be one only, or several may co-exist. The under part of the urethra usually gives way, owing to the direction given to the point of the catheter. Sometimes the catheter, passing beneath the stricture, re-enters the urethra, and is then directed into the bladder, or it may be forced onwards through the prostate gland ; occa sionally the catheter penetrates but a short distance, and on withdrawal enters the na tural passage. False passages through the third lobe of the prostate gland not unrre quently result from unskilful attempts to re lieve retention of urine from enlarged pro state ; in this way the gland may be perforated in three or four places.
When false passages are maintained by the frequent attempts to pass the catheter, they become lined by a mucous membrane, and the urine is in some ever afterwards discharged through the newly formed canals.
Fistula' in perinceo (urinary fistulae) —are a common consequence of ulceration behind a stricture ; they are generally preceded by abscess, and sometimes by gangrene. Not unfrequently they arise independently of any obstruction, as after abscess from acute go norrhoeal inflammation. Urinary fistulm result also from wounds of the canal, as after the operation of lithotomy, or the extraction of calculi from the urethra. Suppuration of the lacunm sometimes leads to urinary fistula : this happens occasionally to the lacuna magna.
In urinary fistula there is sometimes a single opening into the urethra, with many external openings. These are found in various situations: thus they occasionally exist anterior to the scrotum, sometimes in the perinum, and now and then they open into the rectum, or even as low down as the tuberosities of the ischia : the external and internal openings do not always correspond, the intervening tract taking a tortuous course. The walls of the fistula are much thickened and indurated, and this induration extends for some distance to the parts around, and involves a large extent of the cellular tissue and skin, so that the perinmutn feels as hard as cartilage : the canal of the fistula is lined by a mucous membrane.
Sometimes the fistula passes upwards to wards the pubis, and gives rise to inflamma tion and caries of the bone; nay, it may take its course even to the groin and lower part of the abdomen.
For obvious reasons, stricture seldom happens prior to puberty; nevertheless some rare instances are recorded of the disease in young children. I do not here allude to such as result from mechanical injury, for these may happen at any age. Hunter mentions a case of stricture accompanied with fistula in perinmo in a boy four years old, but he does not speak of the cause.* He also mentions one in a boy -eleven years old. In the Museum of the College of Sur geons there is a preparation (No. 2533.) of the bladder and penis of a boy seven years of age, laid open to show a stricture at the mem branous part of the urethra, and behind the stricture a small stone is lodged. The case occurred to Sir E. Home, who also mentions a case of stricture occurring at ten years of age.