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Strictltres and Diverticitla of the Frethra

urine, urethra and diverticula

STRICTLTRES AND DIVERTICITLA OF THE FRETHRA Among other causes of retention of urine congenital narrowing of the external orifice is of importance. Cylindrical stricture was found in one case by Demme. Membranous duplications, producing narrow ing of the canal may be present in the fossa navicularis, and in the prostatic portion. All of these affections present as a common symp tom retention of urine, whieh may be cured by mechanical dilatation of the strictures (in Dernrue's case by the use of laminaria).

The formation of cliverticula of the urethra is rare. We under stand by this term inlets which are connected with the urethra, Bokay distinguishes between true and false diverticula. If the wall is lined with mucous membrane, he speaks of them as true diverticula; if lined with new formed tissue, as false ones. The true may be either congeni tal or acquired; the acquired are due to urethra] calculi or to organic strictures. False diverticula appear if an abscess is formed in the neighborhood of the urethra by strictures, injuries to the inner urethra, or by artificial interference, if the abscess breaks through the wall and forms a sack; or if an abscess is formed near the urethra, but independ ent of it, by an external trauma and becomes a urine-containing bag.

Diverticula seldom result from retention cysts of Cowper's glands.

In none of the congenital cases cloes the diverticulum extend further than the peni-scrotal raphe, while the acquired ones as a rule appear in the perinea] region, and only exceptionally near the glans. Kaufmann names as causes of congenital divertieula:óclisturbances in the juncture of the glands and penile urethra at a time when urine has already begun to overflow from the bladder. This will cause retention of urine, and a dilatation of the lower urethral wall where it is most yielding. In all the eases that have been observed up to this time, the lower wall was affected. The symptoms consist in the swelling or formation of a bag when the urine is discharged, and when the water is retained in it. The urine may be forced out by- pressure. In some cases we find a constant dripping of urine. The treatment consists in operative removal of the diverticula.