Diverticulum of the female urethra

Diverticulum of the female urethra

536 AMFXICAN JOURNAL OF OBSTETRICS AND OYNECOLOOY Kolmer knows of no valid or important reasons ngninst the legal or at delivery. FalseIS reyui...

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536

AMFXICAN

JOURNAL

OF

OBSTETRICS

AND

OYNECOLOOY

Kolmer knows of no valid or important reasons ngninst the legal or at delivery. FalseIS reyuiremeut of blood test,s during pregnancy posit,ive reactions are no nlore likely to occ’ur than in the case of men and nonpregnant women with acceptable methods sl~illfully conducted. It is true that difficult situations may be creat,ed in the case of syphilitic husbands infecting their wives without the knowledge of the latter but. aft,er all, no physician should be a part,y t,o any arrangement that leaves an unsuspecting wife to her fate. It is also true that, women objectiup to blood tests during pregnancy may elect to be delivered by a midwife or neglect calling a physician until in labor. For these reasons, Kolmer believes that the results of a blood test, during pregnancy or at delivery should be required to be reported on all birth certificates.

He&on, Claude p. 1859.

Edwin:

Prenatal

Care,

M.

Clin.

North

America,

November,

1937,

Prenatal care implies constant and efficient supervision with hospitalization for those conditions too serious to be adequately coped with at home. The diagnosis and management of intercurrent or associated conditions complicated by pregnancy necessitate individualization and the aid of internal medicine. Nutritional aspects of pregnancy deserve consideration in the prevention of deficiency states and congenital syphilis is a preventable disease. An effort should be made to prevent eclampsia by prompt attention to signs of hypertensive vascular disease evidenced by a progressive rise of the diastolic blood pressure, protein,uria, upset water balance and spastic changes in the retinal arterioles. Ante-partum bleeding necessitates ruling out placenta previa. Fetal malposition, especially breech presentation, should be corrected where possible. The relative size of the birth canal and passenger should be determined in advance for possible disproportion and for this purpose roentgenography should be utilized. J. P. GREENHILL. Young,

H. H.:

Diverticulum

of the Female

Urethra,

South.

M. J. 31: 1043,

1938.

There are a case report, a review of the literature, and a brief discussion of this anomaly. In a 57.year-old multipara who presented a history of painful, frequent urination with difficulty in starting the stream, a rounded ela.stic mass 3 cm. in diameter was found projecting into the vagina from behind the urethra, Cystoscopic examination revealed an entirely normal bladder. In the floor of the urethra, however, there was noted a small opening which led into a periurethral pouch of a diameter of approximately 254 cm. The relations of this structure to the bladder were demonstrated by cystourethrogram. Surgical removal was successfully accomplished by transverse incision in the vaginal mucosa, dissection of the pouch, and transverse closure of the defect in the floor of the urethra by continuous suture. Patient was relieved of her symptoms. True congenital diverticuli of the female urethra are rare, and usually occur in the median portion of the urethra. Their etiology has not been definitely established, but the possible causal relationship to Miillerian and Glrtner duct remnants has been mentioned. Despite the fact that urethral glands are not commonly found at the usual site of the development of the diverticuli, etiologic importance has been claimed for them by some writers. In the absence of complications such as suppuration, calculus formation, or mechanical interference with urination or coitus, there may be few symptoms. It is suggested that in some cases the condition is overlooked or incorrectly diagnosed as cystocele. AfmoL~ G~LDBERQER.