Urethral Disease in Women
Despite its apparent unimportance, the urethra in women is the site of many distressing ailments and is overlooked by many physicians and not infrequently by the specialist in urology as the possible site of pathologic change productive of urinary symptoms in women. It remained for such workers as Folsom1 to call attention to the prevalence of urethral disease in women; as one speaker (Stark2) has stated, “I would say that the modern urologist had rediscovered the female urethra about 1930.”
The diagnosis, understanding of clinical manifestations, and application of accurate therapy depend upon a knowledge of the gross and histologic anatomy and the pathologic changes involved.
The female urethra is a comparatively short tubular structure extending approximately 4 cm. from the internal urethral orifice at the bladder to the external urethral orifice in the roof of the vestibule. A cross section presents (1) a mucosal lining of squamous epithelium in its outer two-thirds and of transitional epithelium which merges with that of the trigone in its inner third; (2) this lining is thrown into longitudinal folds by a thick muscular coat which is continuous with that of the bladder. There are numerous minute urethral glands and pitlike urethral ducts which open into the lumen of the urethra. One group of these glands on each side possesses a minute common duct known as the paraurethral, or Skene’s, duct, opening on either side of the external urethral orifice. The vascular layer between the muscular coat and the mucous membrane contains elastic fibers. . .