The prolapse may be caused by dilatation of the urethra and the external meatus or by the traction of a neoplasm of the urethra. It sometimes occurs after labor. It may be produced by continual vesical tenesmus, the result of cystitis, calculus, or a tumor of the bladder. The _symptoms_, vesical tenesmus and dysuria, are usually present. Sometimes incontinence of urine occurs. The protruding mucous membrane may become irritated and inflamed, and cause much local pain. It has been known to slough off. _Treatment._--The treatment should be directed, in the first place, to the relief of any causative condition, such as cystitis or calculus. Inflammation of the protruding mucous membrane should be relieved by local applications of hot water and by rest in bed. The mucous membrane should then be gently replaced within the urethra, and contraction of the canal should be promoted by the use of astringent injections of tannic acid or alum. If the disease does not yield to this treatment, the prolapsed mucous membrane should be excised, and the edges of the mucosa should be stitched to the margin of the meatus by fine suture. After this operation there is sometimes cicatricial contraction of the external meatus, which may readily be cured by forcible dilatation. =Vesico-urethral Fissure.=--Vesico-urethral fissure is an ulcerated crack of the mucous membrane situated at the internal urinary meatus. The upper portion extends into the bladder, the lower portion is in the urethra. Skene describes it as “from ¼ to ⅜ of an inch in length, and from 1/12 to ⅙ of an inch in width at the center, but tapering off at each end. The deepest part has a yellowish-gray color, like that of an indolent ulcer, while the edges are red and actually inflamed, like those of an irritable ulcer.” Vesico-urethral fissure is usually caused by urethritis. It may also result from injuries during confinement or from the bungling use of the catheter. _Symptoms._--There is a constant desire to urinate, and urination is followed by severe tenesmus. There is a burning pain at the neck of the bladder, increased immediately after urination. Pressure upon the internal meatus through the vagina may cause lancinating pain. The symptoms resemble closely those of urethritis and cystitis. [Illustration: FIG. 190.--Skene’s urethral endoscope.] The _diagnosis_ of vesico-urethral fissure can be made with certainty only by seeing the fissure through the endoscope. The existence of the condition may be suspected in a woman who presents the symptoms just described, and in whom no signs of inflammation or other disease of the urethra or the bladder can be detected.