Part 49

Treatment, essentially surgical, might include replacing of the organ and suturing of the wound, or, in the absence of a wound, evacuation of the bladder by a hypodermic needle, and replacing by palpation through the vagina or rectum. Sometimes suture of the vulva is desirable.

ANOMALIES OF THE BLADDER.

=Persistent urachus.= Seen in the new born and mainly in males. Antiseptic closure is essential after having ascertained that the urethra is pervious.

=Imperforate cervix vesicæ.= A case reported by Lapotre, in a calf, had no cervix, and the ureters were blocked by pea-shaped nodules.

=Recto-vesical fistula.= In a calf 13 days old the rectum opened into the bladder and the fæces and urine escaped by a pervious urachus. (Kaufmann and Blanc).

URETHRAL ANOMALIES.

Imperforations. In the new born male, foal, lamb, etc. Usually at the outer end, and it may be for some distance back. In one case the sheath was firmly adherent on the wall of the abdomen, thus shutting off all exit of urine. If the canal is absent only at the orifice or for a short distance, the urethra beyond this can be felt full of liquid and fluctuating. The patient being properly fixed a fine trochar is pushed from the end of the penis into the blind end of the urethra, which will be ascertained by the overcoming of resistance. The trochar is now withdrawn and the urine flows through the cannula. A catheter or sound is now tied in the passage to maintain it pervious until cicatrization shall have taken place.

Hypospadias. Short urethra opening backward on the lower surface of the penis. Considered irremediable.

Epispadias. Urethra opening on the upper surface of the penis. Much more rare.

ACUTE URETHRITIS. CATARRH OF THE URETHRA.

This occurs in all genera of domestic animals, and may be either acute or chronic. It is most common in the entire males, not only because of infections sustained in copulation, but because frequent erection exposes the opening of the urethra to injury and inflammation, and to the entrance of pathogenic germs.

Symptoms. Pruritus of the penis, and difficulty and pain in urination and straining are frequent, but a single small jet may be all that is passed at a time. The papilla on the end of the penis is red and angry and somewhat swollen. Later a few drops of muco-purulent fluid may be pressed from the orifice. In the bull, dog and boar this oozes from the retracted penis into the sheath, so that a collection is found in that canal, and the mucosa becomes infected causing a balanitis.

The infection may be conveyed from male to female and vice versa. Dr. Horand of Lyons even found that the muco-purulent discharge of gonorrhœa in man caused an urethral catarrh in the dog, which however did not persist for any great length of time.

Diagnosis is based on frequent and painful urination in jets, tenderness of the urethra under palpation or catheterization, redness and swelling round the urethral orifice, and the oozing of pus. In the absence of any external injury one should always ascertain if cystitis is present.

Prognosis is favorable under appropriate treatment. Spontaneous recovery will usually occur early.

Treatment. Dilute the urine. Give pure water to drink at will, or flaxseed gruel, or gum or barley water. Alkaline carbonates. In the early stage foment and use injection of potassium permanganate (2 grs. to 1 oz.). Later may be used more astringent agents (boric acid 1:100, zinc sulphate 1:100, lead acetate 1:100, potass. chlorate 3:100. In the presence of great pain cocaine muriate 2:100). There is danger of stricture from the stronger astringents or caustics in the early stages before suppuration. To complete the cure give copiaba, buchu, resin, or essence of turpentine.

WOUNDS OF THE URETHRA.

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.

=Catheterization.= In connection with diseases of the bladder and urethra the passing of the catheter is a most important operation which requires considerable skill on the part of the operator. A short statement of the method to be adopted for each of the domestic animals will therefore be in place.