STRICTURE, a morbid contraction of a mucous canal or duct of the body, as the urethra, esophagus, or intestine. When the affected part is not mentioned, and a person is stated to suffer from stricture, it is always the urethral canal that is referred to. Contraction of this canal may be either permanent or transitory. The first form is due to a thickening of the walls of the urethra in consequence of organic deposits, and is hence termed organic stricture. The second may be due either to local inflam mation or congestion, or to abnormal muscular action, the first of these varieties being inflam matory or congestive stricture, and the second spasmodic stricture, of which the last named seldom exists except as a complication of the other kinds of stricture. There are two princi pal causes of organic stricture, inflammation of the canal, and injury by violence. Inflammation is by far the most common cause, and gonor rhoea is the common agent by which it is excited. It is only in exceptional cases that a stricture results from inflammation of the urethra. Stricture in the second case arises from such causes as falling across spars, scaffolding, lad ders, etc., or from some sharp object which punctures the perineum.
The earlier symptoms of stricture are a slight urethral discharge and pain in the canal behind the seat of the stricture at the time of micturi tion. The stream of urine does not pass in its ordinary form, but is flattened or twisted, and as the disease advances it becomes smaller, and ultimately the fluid may only be discharged in drops. The straining efforts to discharge the
urine often induce tenesmus. As the case ad vances the urine becomes alkaline and ropy, and deposits a precipitate when allowed to stand. Attacks of complete retention of urine occur with increasing frequency. But these symptoms are not in themselves sufficient to establish the presence of stricture. It is necessary to examine the urethral canal with a catheter or bougie to ascertain whether an organic obstruction exists, whether one or more strictures are present, and their calibre. The treatment of organic stric ture is chiefly mechanical. It is sufficient to restore the natural calibre of the canal so far as this can be safely effected, and to maintain this patency after it has been established. Spasmodic stricture usually occurs as a com plication of organic stricture or of inflammation of the mucous membrane, but may arise from an acrid condition of the urine, from the ad ministration of cantharides, turpentine, etc., and from the voluntary retention of urine for too long a time. The treatment consists in the re moval of the causes as far as possible and the use of a hot bath. The inhalation of chloro form sometimes gives immediate relief. In flammatory or congestive stricture commonly arises when a recent purulent discharge from the urethra has been checked by external cold or wet. The treatment is much the same as that for retention of urine. Consult Rowlands, R. P., The Operations of Surgery' (New York 1915).