Manual of surgery / by Alexis Thomson and Alexander Miles.

  • Thomson, Alexis, 1863-1924
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: Manual of surgery / by Alexis Thomson and Alexander Miles. Source: Wellcome Collection.

    660/764 (page 640)
    portion of the tube. While cicatricial contraction is the essential factor the narrowing is aggravated by congestion and spasm. Traumatic cicatricial stricture results from injuries of the urethra, the scar tissue being formed during the process of repair. It may follow on the impaction of a stone or foreign body in the urethra, or on rough attempts to remove the same. When due to such causes the stricture usually affects the spongy portion, and may be far forwards near the meatus. When the urethra is completely torn across—for example, the membranous portion in fracture of the pelvis—the torn ends of the tube retract and become widely separated, and during the process of repair the interval comes to be occupied by scar tissue, the urine escaping by a fistula in the perineum. When the rupture is incomplete the continuity of the tube is maintained by part of the mucous membrane constituting a narrow channel in the centre of the scar tissue. Inflammatory cicatricial stricture, while occasionally the result of a urethral chancre or of non-specific urethritis, is in the great majority of cases due to gonorrhea. The gonorrhoea has usually been a persistent one, or there may have been more than one attack. The scar tissue causing the stricture may be placed superficially in the mucous membrane, or it may involve the submucous coat and the erectile tissue. The most common seat of the constriction is at the bulb, but it may affect the penile portion, even close up to the meatus, and there may be several strictures. The scar tissue may be formed chiefly in the floor of the tube, or may entirely surround it—the annular or cylindrical stricture ; or it may form a band across the Jumen— the bridle stricture. When the scar tissue is very dense and unyielding the stricture is described as callous; if it yields to dilatation, but quickly contracts again, it is described as resdlient. If it is possible to pass an instrument through the stricture it is described as permeable ; whereas a stricture through which — nothing can be passed is said to be ¢mpermeable. When the urethra has been torn across or has sloughed the lumen may be entirely obliterated, all the urine passing by a fistulous opening in the perineum. Secondary Changes and Complications.—Behind a stricture the lumen of the urethra and of the ducts and follicles opening into it are dilated, and pockets or diverticula in which secre- tions stagnate are formed. Favourable conditions are thus afforded for bacterial development, the mucous membrane be- comes inflamed, and, with or without a breach of the surface, the infection may spread through at any time to the peri-urethral