FOREIGN BODIES IN THE FEMALE URETHRA.
To the former category belong portions of the contents of the intestine, g-allstones, renal calculi and portions of the kidney substance, echinococcus cysts, vesical calculi and fragments of the wall of the blad der, hair, bones, and teeth derived from the ovaries. In the latter class articles of various kinds have been found, as catheters, hairpins, pins, bits of wood, etc., etc. These become impacted in the urethra either on account of their size or because they have been introduced in a direc tion that has caused them to penetrate the walls of the canal. If a foreign body coming from the bladder is too large to pass, dysuria, strangury or anuria soon manifest themselves. Thus in v. Faber's case there was excessive desire to urinate, with the emission every 5 to 10 minutes of a few drops of clear, yellow urine; after several hours, however, about lbs. of urine was suddenly voided, in which was found a bunch of hair 1 to inches long and about as thick as a stout pen-holder, which was twisted into a plug, and corresponded to the patient's urethra both in size and shape. Undoubtedly the hair had come from a dermoid cyst of the ovary which had penetrated the bladder.
Scanzoni's case, to which we have before referred, shows how vesical calculi may become impacted in the urethra. Ainand removed from the urethra of a puerperal woman an olive-shaped fleshy mas3 containing 15 stones of various sizes.
If the foreign body comes from without and penetrates the wall of the urethra, it may cause local inflammation and abscess, or it may lead to the formation of a calculus in tho urethra itself. Of this kind is the case that Magario has recorded, where a woman 22 years old retained a needle in her urethra for a long time until it eventually penetrated into the vagina. Around it a concretion 3 inches long and 4 inches and 3 lines in circum ference had formed, which could be felt for several lines through an opening in the urethro-vaginal septum. Micturition was dribbling, and
occasioned much pain, although the urethra was greatly dilated; and co habitation always hurt her. The stone was removed by vaginal incision and the patient was cured. Portions of papillomata of the bladder-wall may occasionally plug the urethra, but their softness usually causes them to give way under the pressure of the mine. This is also the case with blood clots from vesical hemorrhage.
Finally, in very rare cases a urethral foreign body may arise from the formation of a calculus or the growth of a neoplasm therein. This oc curred- in our second case of urethral carcinoma; and in a cysto- or urethrocele the urinary salts may be precipitated and form concrements. In Giraud's case it was probably the kick in the perineum which caused inflammation of a urethral lacuna with the subsequent formation of a stone. The e,alculi sometimes found in these lacunse cannot be considered extra-urethral.
The existence of a foreign body in this situation may be ascertained by inspection, when it lies near the meatus urinarius, or by vaginal touch and the urethral sound.
If the foreign body comes from the bladder, and is too large to pass out, the urethra may be dilated, and its extraction essayed with the for ceps. If this does not succeed, it may be carefully pushed back into the bladder, crushed with the lithotrite, and the fragments extracted. If the body cannot be dislodged, a sufficient vaginal incision is to be made longitudinally into the urethra, extraction effected, and the wound im mediately closed with silk or metallic sutures. It heals without difficulty.
Foreign bodies that come from without are to be seized with the t,00thed forceps aud extracted in the direction. in which they entered, if necessary previously dilating the urethra. In most cases this latter procedure will be necessary to find out whether small fragments of the body have not reached the bladder, and if so, to immediately take them out.