Malformations

Occasionally the urethra may be absent, or the superior or inferior walls may be incomplete, giving rise to epispadias and hypospadias respectively.

Inflammation

Urethritis, inflammation of the urethra, is nearly always an infectious condition resulting from the presence of the gonococcus. Non-specific urethritis may be due to injuries or to the entrance of pyogenic micro-organisms. In gonorrheal urethritis the mucosa of the anterior urethra is first involved. It becomes red and swollen and there is soon a formation of pus accompanied by a desquamation of the epithelium. In the pus cells as well as in the epithelial the characteristic organisms will be found. There is generally an infiltration into the deeper layers of the mucosa by the gonococci. The infection may extend to the posterior urethra, and involve the bladder, epididymis, prostate, seminal vesicles, and in women the bladder, vagina, uterus, and Fallopian tubes.

The inflammation in the urethra may subside without doing any damage or it may set up infectious processes in other parts of the body. Is not uncommon to have a gonorrheal ophthalmia, gonorrheal arthritis, an acute endocarditis, or pericarditis.

The acute form of urethritis is often followed by a chronic inflammation called gleet. The posterior urethra is the part generally involved and is accompanied by a very slight discharge of a thick transparent mucus seen in the morning. Not infrequently a fibrous cicatrix is formed in the urethra. This undergoing contraction gives rise to a stricture which is most commonly located in the membranous portion. If the narrowing is severe, the urine may be prevented from escaping, and consequently cause a dilatation of the bladder with hypertrophy and chronic cystitis. The ureters and kidneys may even be involved.

Injuries

The urethra may be the seat of various injuries resulting from direct trauma, external or internal. If it is completely lacerated urine is able to escape into the tissues and rapidly give rise to a suppurative or gangrenous cellulitis. This may be very widespread, including the lower half of the abdomen and the upper part of the thighs. Fistulae communicating with the vagina or rectum or opening externally may be formed.

Tuberculosis and syphilis are rare.

Tumors of the urethra are unusual except when secondarily involved by a neoplasm in adjacent structures, as in squamous epithelioma of the glans penis or in carcinoma of the prostate; in women in cancer of the cervix. The urethral caruncle, found in the meatus in women, is a fibrous angioma. Sarcoma, myxoma, and fibroma sometimes occur.