Actual wounds occur in surgical operations, or accidentally as by shafts, poles, forks, hooks, bites, etc., or from calculus or a catheter forced into a false route. An arrested or slowly moving calculus has been known to induce several perforating ulcers causing infiltration of urine and infecting germs into the connective tissue. This determines rapidly increasing œdematous fluctuating tumors. Gangrene and septic intoxication are common results, especially in cattle.
Longitudinal wounds keep more open and heal more readily than transverse wounds, probably because the circular muscular fibres in contracting, pull the edges apart and counteract stricture, the breach being filled up by granulations. The perineal wound in lithotomy will heal thus in 20 days, while that made in amputation of the penis is exceedingly liable to circular contraction and stricture or occlusion.
Contusions of the perineum, may cause lacerations of the urethra and hæmorrhages, with bloody discharge or sanguineous swelling.
Treatment. Will vary. Calculi must be diagnosed and removed. Breach of the walls of the urethra may necessitate frequent catheterization or, better, the wearing of a catheter. Escape of urine into the connective tissue should be met by a counter opening in the skin to drain the part and allow free antisepsis. Similar resorts are required for urinary infiltration, accompanied by antiseptic injection subcutem. Abscesses must be located, punctured with trochar and cannula, evacuated and injected antiseptically.
FOREIGN BODIES IN THE URETHRA.
Apart from calculi, may be found straws, glumes, chaff and catheters and even stones and small bodies which must have been introduced deliberately. An irritation corresponding to the offending mass and its seat, ensues, and must be treated by soothing and antiphlogistic measures while the offending body must be found and completely extracted.
STRICTURE OF THE URETHRA.
This may be suspected when in spite of much straining the urine is habitually passed in a very fine stream, which has become finer and finer for a length of time, without complete arrest as in calculus. The introduction of a catheter will confirm the diagnosis and show the exact seat of the stricture.
It is determined by irritation caused by calculus, urethritis, ulcer, wounds, etc., which tend to the formation of a cicatrix encircling and narrowing the canal. One efficient cause is the injection of strong astringent or slight caustic solutions in the early stages of urethritis.
Treatment is by dilation, by bougies pointed and gradually thickening, or simply by an elastic staff which at first passes with some force and is replaced by a larger one as the urethra stretches under daily use.