A Text-book of Diseases of Women

by Charles B. Penrose

The condition may be determined by the insertion of sounds or the finger.

Treatment should be directed to the cure of any inflamed condition of the urethra which may accompany dilatation, and to the use of astringent injections of tannic acid.

If incontinence of urine persists it may be necessary to perform a plastic operation, excising a portion of the anterior wall of the vagina and the posterior wall of the urethra, and closing the wound by transverse sutures.

In urethrocele the dilatation is confined to a portion of the urethra, usually the middle third. There is a sacculated condition of the posterior wall of the urethra extending into the vagina. The usual cause of this condition is traumatism during labor. The symptoms are painful and difficult micturition and partial incontinence of urine. The condition may be diagnosed by the use of the sound or the probe, which may be inserted in the sac through the urethra, when the point may be felt by a finger on the anterior vaginal wall. Sometimes the urethrocele produces a distinct bulging in the anterior wall of the vagina.

If the annoying symptoms of urethrocele continue after any accompanying inflammation of the urethra has been relieved, it may be necessary to excise the sacculated portion of the urethra by incision through the vaginal wall and close the wound by suture.

URETHRAL NEOPLASMS.

Urethral Caruncle.—The urethral caruncle is a small raspberry-like tumor situated at or just inside of the external meatus. It is composed of dilated capillaries set in a dense stroma of connective tissue and covered with mucous membrane. The tumor varies in size from a pin-head to a hickory-nut. In color it varies from a pale to a bright red. It is usually situated upon the posterior wall of the urethra. There may be two or more such· tumors around the circumference of the meatus, and occasionally they are found in the vestibule. The growth is usually sessile.

The caruncle is often erectile in character, and increases in size at the menstrual period.

The growths bleed very easily on manipulation, and are exquisitely sensitive. The urethral caruncle is the commonest neoplasm of the urethra.

Symptoms.—The most marked symptom of urethral caruncle is pain. Intense pain is experienced at micturition and upon contact with the clothing or other body. Sexual connection is sometimes rendered impossible.