Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
Fig. 1, Plate 56, represents by section the natural forms of the urethra
and bladder. The general direction of the urethra measured during its
relaxed state from the vesical orifice to the glans is usually described
as having the form of the letter S laid procumbent to the right side
[capital S rotated 90 degrees right] or to the left [capital S rotated
90 degrees left]. But as the anterior half of the canal is moveable, and
liable thereby to obliterate the general form, while the posterior half
is fixed, I shall direct attention to the latter half chiefly, since
upon its peculiar form and relative position depends most of the
difficulty in the performance of catheterism. The portion of the urethra
which intervenes between the neck of the bladder, K, and the point E,
where the penis is suspended from the front of the symphysis pubis by
the suspensory ligament, assumes very nearly the form of a semicircle,
whose anterior half looks towards the forepart, and whose posterior half
is turned to the back of the pubis. The pubic arch, A, spans crossways,
the middle of this part of the urethra, G, opposite the bulb H. The two
extremes, F K, of this curve, and the lower part of the symphysis pubis,
occupy in the adult the same antero-posterior level; and it follows,
therefore, that the distance to which the urethra near its bulb, H, is
removed from the pubic symphysis above must equal the depth of its own
curve, which measures about an inch perpendicularly. The urethral
aperture of the triangular ligament appears removed at this distance
below the pubic symphysis, and that portion of the canal which lies
behind the ligament, and ascends obliquely backwards and upwards to the
vesical orifice on a level with the symphysis pubis in the adult should
be remembered, as varying both in direction and length in individuals of
the extremes of age. In the young, this variation is owing to the usual
high position of the bladder in the pelvis, whilst in the old it may be
caused by an enlarged state of the prostate. The curve of the urethra
now described is permanent in all positions of the body, while that
portion of the canal anterior to the point F, which is free, relaxed,
and moveable, can by traction towards the umbilicus be made to continue
in the direction of the fixed curve F K, and this is the general form
which the urethra assumes when a bent catheter of ordinary shape is
passed along the canal into the bladder. The length of the urethra
varies at different ages and in different individuals, and its structure
in the relaxed state is so very dilatable that it is not possible to
estimate the width of its canal with fixed accuracy. As a general rule,
the urethra is much more dilatable, and capable consequently of
receiving an instrument of much larger bore in the aged than in the
adult.
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