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Stricture of the

urethra, physician, patient and time

STRICTURE OF THE URETHRA.A contracted condition of the urethra. This may he due to various causes, but the most common are injuries of the mucous membrane of the urethra and of the tissues sur rounding it, chronic gonorrhea, and, too often, the inappropriate and corrosive injections used in the faulty treatment of gonorrhoea. An injury of the urethra is always accompanied with haemorrhages, often with retention of the urine. After the occurrence of such injuries, which are mostly brought about by a fall, by pressure, or by a blow in the region of the perineum, it is imperative at once to consult a physician. Until he arrives, the patient should keep as quiet as possible, and cold should be applied to the injured part. Strictures arising in consequence of gonorrhoea appear slowly and insidiously, the stream of urine gradually diminishing in strength and diameter until it is voided only in drops. Finally, its discharge is attended with pain, and can be accomplished only with the aid of abdominal pressure. Changes take place in that part of the urethra which is situated behind the stricture, and affections of the bladder set in. Individuals who have been afflicted with gonorrhoea for a considerable time should pay attention to these manifestations in order to avoid the more marked degrees of stricture, which often can be removed only by operation.

Treatment, otherwise than by surgery, is largely mechanical, distension being accomplished gradually by the introduction of sounds of increasing thickness. As this process is sometimes entrusted to the patient himself,

it is advisable to state that the sounds which are employed should always be carefully disinfected, that they must be lubricated, and that, to avoid the much-dreaded " wrong passages," force should never be used when pushing the sound through the narrow place. It is best, however, to leave this distension-cure in the hands of the physician ; and only exceptionally should the patient, with the permission of the physician, and instructed by him, undertake the process for himself. Even after the cure is completed, it is necessary that the physician from time to time make a controlling examination to determine whether the result which was finally obtained, and which is sufficient for normal function, has remained a permanent one. Unfortunate events, such as hmnorrhages of the urethra, irritation of the bladder, and suppurations in the tissues surrounding the urethra, always require the attention of a physician, as they may eventually threaten the life of the patient, and must always be looked upon as considerable disturb ances to the course of recovery. Entrance of urine into injured tissues may, under some circumstances, give rise to blood-poisoning.