Treatment. When the sheath is filled with sebaceous material or foreign substances it may be necessary to cleanse it daily with mild antiseptic injections. Some practitioners recommend laying open the external orifice, an operation which may be performed in the standing position. This, however, is not without danger, and infection may easily occur.
When the subcutaneous connective tissue surrounding the sheath and the glans penis is infiltrated and inflamed, the inflammatory swelling must be examined every day, so as to detect the abscesses as early as possible, and open them without delay. Under some circumstances deep firing in points produces very favourable results.
When an abscess has caused partial necrosis of the sheath, it is well to pass a drain and wash out the parts frequently with antiseptic solutions. For this purpose a counter-opening is made through the skin opposite the fluctuating point. The mucous membrane of the sheath is then cautiously punctured, and a seton or strip of gauze is passed by means of a seton needle, so as to allow of constant drainage.
PERSISTENCE OF THE URACHUS.
This condition is an infirmity or congenital anomaly, rather than a morbid condition. Persistence of the urachus after birth and after separation of the cord is due to the fact that the canal which communicates with the bladder fails to close up. The urine, instead of escaping through the urethra, passes along the urachus, and the animal urinates through its umbilicus.
Causation. The causes are simple. Certain practitioners have suggested that sex has some influence, this being an anomaly occurring more frequently in males than in females. From investigations which have been carried out, it would appear that, in some cases, persistence of the urachus is due to an imperforate condition of the urethra; in other cases, to its obstruction by accumulations of mucus of a caseous appearance, which enter the urethra and completely block the passage. Finally, in other cases the urachus simply persists while no lesion exists on the side of the urethra.
Whatever the original cause, escape of urine by the umbilicus produces irritation, which may end in complications, infection of the unhealed umbilical wound, infection of the canal of the urachus itself and the bladder, or even infection of the peritoneum.
Symptoms. At first, persistence of the urachus is shown by permanent or intermittent discharge of urine through the umbilicus. Usually this discharge is only seen from five to eight days after birth, when the necrosed cord is detached; in most cases it is continuous, for the opening is abnormal and has no sphincter.
Contact with the air and the wound causes the urine to undergo a kind of ammoniacal fermentation and to irritate neighbouring tissues, such as the stumps of the umbilical vessels, the interstitial connective tissue, and even the skin. The wound constitutes an excellent culture medium for microbes. The umbilicus becomes swollen and œdematous, and soon exhibits a saccular swelling, 2 to 4 inches in diameter, which, on palpation, proves to be hot and painful; its centre is occupied by the opening of the urinary fistula. A probe passed into this fistula travels upwards and backwards (see Fig. 183).
At a later stage other complications, including omphalitis and omphalo-phlebitis, may set in. The most frequent of the delayed complications is purulent cystitis, with the formation of purulent concretions in the bladder, which may occur even after the fistula of the urachus has healed. In other cases the canal of the urachus contracts and becomes obliterated towards the bladder. A blind fistula then persists, with an opening at the umbilicus, or, the parts having healed externally, all that remains is a phlegmonous swelling with the characteristic symptoms.