Diseases of the urinary and male sexual organs / by William T. Belfield.

  • Belfield, W. T. (William T.)
Date:
[1884], ©1884
Catalogue details

Licence: Public Domain Mark

Credit: Diseases of the urinary and male sexual organs / by William T. Belfield. Source: Wellcome Collection.

    36/372 (page 22)
    thral muscles ; operations upon the anus or rectum are frequently followed by complete retention of urine owing to the reflex spasm of the urethral muscles. Simple nervous excitement or exhaustion may arouse such spasmodic contraction of the urethral compressors as to render urination temporarily impossible. In such cases the introduction of the catheter reveals a de- cided obstacle to its passage—a spasmodic stricture. The possibility of spasmodic stricture is practically denied by Sir Henry Thompson. Of it he says : '^It is an exceedingly useful excuse for the fail- ure of instruments. It is a refuge for incompetence. Spasm may prevent the urine from going outward; I do not know that it ever prevents the instrument from going in. Notwithstanding Sir Henry's scepticism there can be no doubt that spasmodic contraction of the urethral muscles may attain such a degree as to oppose and even temporarily prevent the en- trance of a catheter. Surgeons who certainly understand the introduction of the catheter, and who need no refuge for incompetence, have placed upon record instances of spasmodic stricture. Thus Dittel has seen it as the result of simple acidity of the urine and in cases of diabetes mellitus, irritation of the anus by worms, fissui-es, etc. ; and he narrates several cases in which no other cause than mental excitement could be assigned. A Vienna physician was called to see a lawj^er who was preparing for a journey and suddenly suffered retention of urine. The physician at- tempted to introduce a catheter, but met an insurmountable obstacle in the membranous portion. The patient was taken to Dittel, who passed a No. 25 r. without trouble. Two years later the same phenomenon oc- curred in the same person. This time Dittel, in attempting to introduce a catheter, met an obstruction in the membranous portion, which yielded only after the catheter had been firmly pressed against it for fifteen minutes. I was once consulted by a medical student, who upon the eve of an ex- amination for which he had been industriously preparing, suddenly found himself unable to evacuate his bladder. By persistent straining he was successful in expelling only a very small amount of mine, which dribbled away in a small and jerky stream. He stated that for several days pre- ceding the occurrence he had experienced difficulty in urination, being often compelled to wait some minutes before the urine would flow ; and he sometimes felt sure that he had not completely evacuated the bladder. He had never had gonorrhoea nor any other affection of the urinary organs previous to that time. After several unsuccessful attempts to introduce different catheters, I succeeded in overcoming the resistance, which was located in the membranous portion, by continuous pressure for several minutes with a small conical metallic instrument. Curious to know whether or not this was an instance of spasmodic stricture, or merely of my incompetence, I secured the patient's permission to try again, several days after he had successfully passed the examination. At this time I found no difficulty in introducing different catheters into the bladder. That a spasmodic contraction of the urethral muscles should exist is certainly not remarkable. An analogous spasm of the sphincter ani is a fre- quent phenomenon in cases of ulceration of the rectum or fissure of the anus ; indeed, in these conditions a spasmodic contraction of the sphincter of the bladder, causing complete retention of mine, is not infrequent. The sphincter of the vagina exhibits a similar spasmodic condition in cases of vaginismus. It has been asserted that spasmodic contraction of the urethral muscles may exist for years, causing all the symptoms of organic strictm-e, and so