Obviously the constantly accumulating urine, a waste-product of the body, must have some channel for escape, and, if the urethra become impervious, Jistulce, or false passages form, and the urine finds its exit through one or more openings in the penis, scrotum, or surface of the belly; or else the bladder bursts and the patient rapidly dies from shock.
It may be years after the patient has considered himself cured of the gonorrhoea before the obstruction to the flow of urine becomes so marked as to arrest his attention; for gonorrhoea does not promptly cause stricture these lesions, as a rule, requiring years for their development.
An expert rifle-shot takes great pains to keep the inside of his rifle-barrel untarnished and in perfect order; if it become in the least degree rusted, it is never the same, while if it have become badly corroded, even in one spot, it is useless for marksmanship until re bored to a new calibre. So, also, a stricture converts the urethra into a "pathological tube" and unfits it for its proper function. Just as the rifle-barrel must be re bored, in very nearly the same manner the surgeon must almost literally re bore and cut and stretch the scarred urethra.
True gonorrhceal stricture is found only in the anterior urethra, i.e., from a point in the urethra slightly posterior to the peno-scrotal angle forward to the meatus. There is, however, an inflammatory condition caused by the stricture in the anterior portion, which secondarily affects the posterior urethra and neck of the bladder. A stricture is said to exist when the calibre of the urethra is diminished from its normal size, in which event it becomes necessary for the surgeon to restore its patency if the patient is to be in health.
The duration of the treatment required lasts, generally speaking, for a period of months, with a supervision extending over years or a lifetime; and it is left for the reader to imagine, if he can, the amount of time and money expended, the inconvenience, and the suffering physical and mental. There is sometimes a spasmodic stricture, which results from an inflamed and hypersensitive condition of the urethral mucous membrane. This may be caused by the use of an improper saddle, whether on a bicycle or horse, by alcohol or sexual excesses, by colds, irritating condition of the urine, piles, fissure of the anus, constipation, etc.
It is due to contractions of the compressor urethrse muscle and of the muscular fibres of the urethra itself; and when catheter or sound is passed down a canal so affected there is a sensation of the instrument being firmly grasped by the muscles, or the urethra may close so firmly as to refuse to admit an instrument.
These spasmodic strictures are sometimes troublesome in preventing urination, but we do not look upon them as serious, since they usually pass away without serious results.
1, the soft stricture;
2, the semi-fibrous stricture; and,
3, the densely fibrous, or modular stricture, where the urethra is surrounded by an irregular and firm mass of dense, gristly, scar-like tissue. The last and most serious variety results, in gradations, from the second and first forms. The soft stricture is the first to develop, usually in the bulbous portion of the urethra, and the disease may usually be arrested at this stage.
If the case be neglected, however, fibrous tissue forms at the site of the soft stricture and constitutes the semi-fibrous stricture. Here the process may again stop; but if the case is treated not at all, or improperly, then a new and firmer growth of fibrous tissue takes place, entirely obliterating the normal structures, so as to form a non-elastic, gristly and densely fibrous, or inodular stricture. Thus we see that the semi-fibrous stricture develops from the incipient soft stricture into the densely fibrous variety, and that these three forms are merely different stages which represent the increasing severity of the lesion.
It will be well to remember that in every case of gonorrhoea which becomes chronic there is, on account of the continued inflammation, a growth of new cell elements, which infiltrates the tissues lying immediately beneath the urethral mucous membrane, and that, unless this condition receives skilful treatment early in its inception, it will result in a serious, permanent injury to the urethra, reducing its calibre and impairing its dilatability.
The soft stricture, or earliest and least severe of the varieties, may remain soft for months or years, always having a tendency, however, to become firm and fibrous and to contract, which it certainly will do upon the slightest provocation, e.g., from inordinate sexual indulgence, a reinfection of gonorrhoea, severe exercise, or, in short, from any cause which may inflame the damaged urethra.