Tissue removed at Richardson urethroplasty from 50 patients with the urethral syndrome, together with material obtained from the urethras of 44 cadavers, was examined in an attempt to elucidate the pathological basis for this syndrome. There was a significant increase in fibrous tissue in the urethrovaginal septum, accompanied by a loss of smooth muscle fibres and focal clumping of elastic tissue, in patients with the urethral syndrome.