Urethritis Follicularis

Abstract

AVAILABLE published works, including text--**-books, are rather vague in their description and evaluation of the nodular or polypoid protuberances frequently encountered at the proximal portion of the female urethra and bladder neck. These nodules are visualized with the foroblique telescope and the McCarthy cystourethroscope by withdrawing the instrument into the urethra with the irrigating fluid actively flowing. Some are clubshaped, with a small pedicle; others are blunt, with a broad base. While they appear to be more commonly situated near the bladder neck, they may extend for a variable distance into the urethra. The nodules are covered by normal-appearing mucosa. Careful observation usually reveals one or more blood vessels entering them at the base. These projections have been frequently referred to as inflammatory tags or polyps of the female urethra.Because of their obviously benign character, they have seldom been subjected to biopsy. I have removed a few of these nodules from 3 women for microscopic study. The patients were in their third, fourth and fifth decades respectively. All 3 showed infection of the uterine cervix and pus and bacilli in the urine obtained by catheterization. Two had cystoceles with incontinence. One had a proved papilloma of the bladder near the right ureteral orifice, and a right pyelonephritis presumably associated with the mild obstruction occasioned by the papilloma. No patient had at any time had hematuria, although it was present in several of the reported cases of follicular lesions elsewhere in the urinary tract. The biopsy specimen in each case revealed a solitary lymph follicle with densely packed lymphocytes at the periphery and a typical germinal center (Fig. 1).This lesion is not confined to the female urethra. Figure 2 shows the typical lymph follicle from a presumed polyp removed from the prostatic urethra near the internal orifice of a sixty-two-year-old man with a profound bacillary infection secondary to an infected hyperplastic prostate.In one of the sections taken from the female urethra, lymph follicles and glandular structures were found in the same polypoid mass (Fig. 3).In the gross this structure differed not at all from the others.Since there is a paucity of literature on urethritis follicularis, it should prove profitable to review briefly some of the more recent reports on follicular lesions elsewhere in the urinary tract. Kretschmer1 in 1913 reviewed the literature on pyelitis follicularis and found only 7 cases. Of these the bladder was involved in only 2 cases, 1 of these being Kretschmer's. Hundley and Carson2 in 1929 added 3 more cases of pyelitis follicularis to the literature. Hinman and Cordonnier3 studFigure 1. Solitary Lymph Follicle in a Polypoid Mass Removed from the Proximal Portion of the Urethra in a Woman.ied 7 cases of cystitis follicularis and biopsied 5. Six patients were women and 1 a man. The ages ranged from eight to sixty-nine, although most of the patients were over forty. Colon bacilli were present in the bladder urine at in...