Extravasation of urine, or a diffusion of urine into the surrounding tissues, occurs when the urethra ruptures at the site of the inflamed and devitalized area. It is an exceedingly grave complication of stricture and always requires prompt surgical aid. It is rendered especially grave from the fact that the urine of patients who are suffering with tight strictures is usually foul and decomposed, and urine in such a condition rapidly sets up blood poisoning and extensive necrosis, or gangrene, of all tissues outside of the urinary passages, with which it comes in contact. The rupture of the urethra may occur when the patient is straining to urinate, or from an uncontrollable spasmodic effort on the part of the abdominal muscles and bladder. At first the patient may experience no pain, but even a feeling of relief from the desire to urinate, though he is surprised that relief has come without the passing of anj urine.
The condition is somewhat analogous to what occurs when a garden hose breaks at some part of its course, the water leaking out at the break, but none, or little, coming from the nozzle. The urine which leaks out at the site of the break diffuses itself through the tissues and burrows through them in various directions, causing them to swell wherever it goes. The swelling is limited to the subcutaneous tissues of the penis, scrotum, perinssum, and walls of the abdomen. This extravasated and putrid urine continues to tunnel passages for itself in various directions and by its decomposition sets up symptoms which are indicative of blood poisoning, such as nausea, vomiting, loss of appetite, high fever, chills, ursemic coma, delirium, and death if surgical aid be not promptly given. Sometimes the effect of this putrid urine is to cause extensive sloughing of the skin surfaces, so that the testicles may be left bare and denuded of their scrotal covering.
After the rupture the patient will be unable to urinate, and a surgeon is quickly called in.
Abscess of the prostate sometimes develops as a result of stricture. If the inflammation of the prostate gland, which surrounds the prostatic portion of the urethra, go on to end in pus formation, the patient will suffer with a throbbing pain at the neck of the bladder, and an impediment to the free passage of urine will occur on account of a pressure on the urethra by the enlarged prostate, which may completely close it. In such cases the muscular force demanded of the bladder, in order to expel its contents, is so great that the bladder walls become enormously hypertro phied and more powerful, the thickening in some cases being five or six times as great as normal. As a consequence of this hypertrophy of the bladder walls, the mucous membrane which lines the bladder gets thrown into numerous deep folds, and on account of the powerful straining efforts to evacuate the urine, large pouches or sacs form, which may even become larger than the bladder itself.
In these pouches the urine stagnates and putrefies, and their walls tend to become thinner and thinner from over distention, while calculi, or stones, very frequently form in them by a morbid deposition of the earthy matter and salts of the urine. Sometimes the pouches become so attenuated that they burst and allow the putrid urine to escape into the abdominal cavity, in which event death speedily occurs from shock or peritonitis.
Changes in the Urine in Stricture. In severe and neglected cases of stricture some of the urine is retained in the bladder and decomposes, with the result that the kidneys become involved, and herein lies the chief danger; not in the impediment to urination per se, but in the retention of a portion of the decomposed and septic urine.
Such urine putrid, fetid, and highly poisonous may so alter the structure of the kidneys by the inflammation excited in them that they cannot eliminate the urine from the system. The patient's condition is then truly pitiable. He is gravely ill and suffers with urinary fever, severe pains in the back and loins, and dropsy. He usually makes the effort to pass urine every few minutes, perhaps succeeding in voiding at each trial only a few drops of offensive and putrid urine which scalds the urethra. The suffering is intense, and such severe cases usually end fatally. The Causes of Stricture. The chief cause is long continued inflammation following gonorrhcea, which leads to the growth of cicatricial, or fibrous, tissue in and about the walls of the urethra. A stricture is more apt to follow a gonorrhcea which has lasted for a long time, no matter how mild the attack was; the sharpness of the attack having less to do with the recovery than the length of the period of convalescence. We have already discussed spasmodic strictures, but there yet remain two or three rarer varieties. Syphilitic sores at the meatus are sometimes followed by stricture, and excessive masturbation is said to cause it in some instances by exciting an active congestion and inflammation of the urethral mucous membrane. In a few other cases strictures may be caused by the use of caustic or irritant injections used in the attempt to abort gonorrhoea.