[Reprinted from The MEDICAL News, April 20, 1895.] 
STRICTURE OF THE URETHRA IN WOMEN. 
By WILLIAM S. BAGOT, M.D. Dublin Univ., 
of xlewver, col. ; 
EX-SENIOR ASSISTANT PHYSICIAN ROTUNDA LYING-IN HOSPITAL, DUBLIN, 
[IRELAND ; VISITING GYNECOLOGIST TO ST. LUKE’S AND ST. 
Joseph’s hospitals. Denver, and professor of 
OBSTETRICS AND ABDOMINAL SURGERY, 
UNIVERSITY OF DENVER. 
Stricture of the urethra is an affection that is 
met much less frequently in women than in men. 
So far about sixty cases have been reported since 
1824, when Lisfranc first drew attention to this con- 
dition. The facts that this affection is more easily 
remedied in women, and that in them the slighter 
forms are apt to pass unnoticed or neglected, ren- 
der it probable that, had all such cases been re- 
ported, their number would have been considerably 
augmented. The most frequent cause of stricture 
of the female urethra is gonorrheal urethritis. In 
these cases the formation of the stricture, as a rule, 
takes place more slowly than when due to other 
causes, the symptoms appearing on an average about 
the eighth year after the onset of the gonorrhea. 
In some cases, however, stenosis appeared as early 
as the end of the first year, while in rare cases it 
may be delayed till the twentieth year. Van de 
Warker and Genouville believe that, contrary to the 
statement of Ricord and Reybard et Fissiaux,steno 2 
sis of the urethra is followed by symptoms of dysuria 
more rapidly in women than in men. Genouville 
explains this by the fact that the female bladder is 
less muscular and more distensible than that of the 
male, and, consequently, its functions will be more 
easily interfered with by any obstruction in the 
urethra. Strictures following gonorrhea constitute 
about one-third of all the reported cases, the average 
age of these patients being about thirty-nine years. 
Injuries during labor and puerperal inflammatory 
processes involving the urethro-vaginal septum, and 
resulting in the formation of cicatricial bands, may 
cause constriction of the urethral canal. Scanzoni 
has reported a case in which such a stricture resulted 
from a gangrenous colpitis following a forceps-de- 
livery. Neoplasms of the urethral walls may obstruct 
the lumen of the urethra, as in David’s case (Gaz. 
des Hop., 1870, lxxiii). 
Stricture resulting from a urethral chancre is rare, 
but cases have been reported by Scanzoni, Velpeau, 
and Larcher. Two such cases came under my 
notice at the Rotunda Lying-in Hospital. In both 
the site of the stricture was immediately inside the 
meatus externus. 
Two cases of congenital stenosis have been re- 
ported, one by Blum and the second by Fissiaux. 
In both the urachus persisted, and the urine oozed 
from the still patent umbilicus. 
Senile contraction has also been cited as a cause 
by Herman. I have seen one case in which a marked 
stenosis of the meatus externus existed in a patient 
who had suffered for some time from the disease de- 
scribed by Breisky as kraurosis vulvae. 3 
When a vesico-vaginal fistula has existed for a 
considerable time the urethra may become greatly 
contracted from disuse (Skene) or from having been 
involved by the inflammatory processes at the time 
of the formation of the fistula. Too extensive ap- 
plication of any form of cauterization will also 
produce cicatricial narrowing of the urethra. 
Most frequently the stricture is situated in the 
anterior third of the urethra, usually at or near the 
meatus externus. In rare cases several strictures may 
co-exist. 
The symptoms of urethral stenosis are difficulty 
in micturition, with or without pain; gradually, as 
the stenosis becomes more marked, the stream of 
urine becomes less in volume, till it is voided only 
drop by drop; or, eventually, complete retention 
takes place. Should cystitis also be present, we find 
frequent desire to urinate, vesical tenesmus, the 
passage of pus and perhaps of blood in the urine. 
Owing to the resistance that it has to overcome, the 
bladder-wall becomes hypertrophied. Scanzoni has 
drawn attention to this condition and the effect 
which it produces on the internal genital organs. 
He has seen prolapse of the anterior vaginal wall 
result from it. Two cases of rupture of the bladder 
from over-distention, due to this cause, have been 
recorded. As in the male, here, too, cystitis, fol- 
lowed by ascending ureteritis and pyelo-nephritis, 
may set in and result in a fatal termination. 
As a rule, the diagnosis is easy, the stricture being 
situated, in the majority of cases, in the anterior 
third of the urethra. On passing a sound along the 
urethra and following its course with the index-finger 4 
in the vagina an induration can usually be detected 
at the point where the sound is arrested. In this 
way, also, any cicatricial bands in the vagina which 
may be compressing the urethra can be palpated. A 
careful examination will exclude retention from 
pressure by neoplasms in the urethral walls or in the 
pelvis, retroversion of the gravid uterus, hematocele, 
etc. 
The urine should be carefully examined so as to 
exclude cases in which the frequency of micturition 
and hindrance to the entry of the sound into the 
bladder arise from the presence of cystitis. 
Calculus can be eliminated from the diagnosis by 
a careful bimanual examination of the bladder, com- 
bined with cystoscopy or sounding. 
In most cases gradual dilatation performed every 
two or three days with Simon’s urethral specula or 
Hegar’s dilators will bring about a cure. Care should 
be taken to lacerate the urethral mucous membrane 
as little as possible in carrying out the dilatation. 
Should this prove ineffectual, external or internal 
urethrotomy may be performed. When the stricture 
is situated in the anterior part of the urethra, close 
to the meatus, complete division of the stricture 
and the urethro-vaginal septum may be performed, 
and the urethral mucous membrane stitched to the 
vaginal mucous membrane, thus transforming the 
two passages from the seat of the stricture to the 
meatus into one canal. Should cicatrices exist in 
the vagina they should be divided or excised. When 
there is much periurethral thickening vaginal 
douches of warm sublimate-solution and tampons 
of iodoform-gauze saturated with a solution of 5 
ichthyoland glycerol (io percent.) maybe employed 
to assist in reducing it. When the obstruction is 
due to the presence of a new growth this should be 
removed. To perform internal urethrotomy Winckel 
advises that the urethra should be dilated till the 
seat of the stricture will admit the finger. A knife 
is then passed in with the blade held flat against the 
finger; after passing it through the seat of the stric- 
ture the cutting edge of the knife is turned and 
pressed against the cicatrix, so as to divide it com- 
pletely during the withdrawal of the blade. Should 
any excessive hemorrhage occur a large urethral 
bougie may be introduced and left in situ, so as to 
compress the bleeding point. The dilatation should 
afterward be maintained by the use of bougies if 
there is any tendency for the stricture to recur. In 
all cases the patient should be taught to introduce 
the bougie herself, and warned to return at once for 
treatment should any difficulty in micturition reap- 
pear. Resection of the strictured portion of the 
urethra after the method employed by Jouon in the 
male (Sent. Med., May 14, 1892) may be performed 
in cases in which the foregoing methods fail. The cut 
surfaces are united by fine catgut sutures. I have 
employed this procedure with good result in a case 
of traumatic stricture situated in the middle third 
of the urethra. Electrolysis has been successfully 
used by Newman and Fissiaux in their cases. Though 
good results have occasionally been obtained by 
rapid forcible dilatation, it should be discarded, as 
it may lead to persistent incontinence, and has no 
advantage over gradual dilatation. Verneuil lost 
one case treated by this method. Probably, how- 6 
ever, with the recent advantages of asepsis any 
danger as regards the life of the patient can be alto- 
gether obviated. In cases in which, with narrow- 
ing of the urethra, there is also present a vesico- 
vaginal fistula the former condition should be,at- 
tended to before attempting to close the fistula.