Vol. 60, 1909 - University of North Carolina at Chapel Hill

;
THE CHARLOTTE MEDICAL JOURNAL. 9
tieiit now gets disturbed about himself and this condition under his observation. Perconies
for examination.
There are many classifications and divisineal
section, stellate rupture of the stenosed
ring ( which would not admit a No. 12
ions of the degrees of prostatic hypertro* I-\) by means of uterine dilators, dilatation
phy. The writer had the opportunity be- to 4.5 F. bj' Kollman's dilator, insertion of
fore the Medical Society of \'irginia, in a large perineal tube and usual after-treat-
1007, to make the following: nient were followed by most gratifying and
I. Enlarged prostate characterized by durable results. Large sounds must be
moderate frequency of urination.
lix>>ninatwyi— Bladder healthy; residual,
passed at regular intervals to maintain this
patency,
two ounces or less and clear; organs nor- Just here, the writer would call attention
nial; health good; patieiK does not know he tothe following personal observations which
has it. are that contracture of the neck of the blad-
II. Enlarged prostate characterized by der occurs more frequently than is supposed
"catheter life" or overflow.
F.y.amiiiation— Bladder tired out and inand
that the sound inserted on deep dilataion
never gains the bladder cavity and,
fected. Residual, large amount and nasty therefore, does not dilate the internal
kidneys and heart compensating; able to sphincter; that the stenosis is shoved on
attend to work. ahead of the sound which is not sent home,
III. ]*)nlarged prostate, really Class II the operator is deceived, the condition not
plus infection (general and local).
Exaviination—Kidneys and heart not
relieved and the patient ultimately comes
to the operating table seeking permanent
compensating; urosepsis; delirium. relief.
Those cases in class 1 1 constitute the Along with this series of cases also, there
larger percentage of the instances which
the surgeon sees. We rarely see those in
were three cases of cancer of the prostate
which proved inoperable. In the early
Class I. for they are like the boy whoswallowed
the nickel,—they have got it and
don't know they've got it.
stages of cancer, the stony hardness, iramo-
bility and glandular involvement point to
the condition, and, later, these same epi-
Class II. is also essentinlly the class for phenomena and particularly the doing-away
operation. They cannot be convinced in with the sulcus posteriorly stamps the dis-
Class I. that surgical procedures are justi- ease as malignant and beyond surgical re-
fiable; and in Class III. the urosepsis and lief. The writer would call attention to a
systemic infection are so profound that op- case of cancer of the floor of the bladder,
eration must be attended with a large mor- A suprapubic cystostomy was performed; a
lality. tumor the size of a child's fist was removed.
The writer would call attention to the the base seared, and for five weeks, every
prostatic pouch as a reservoir for urine, other day. the x-ray was applied through
which, at times, is misleading. This pouch the bladder wound ujion the stump by Pifistliedilated
firoslatic urethra liounded ante- fard's protecting tul)e. Dr. Cray tiien conriorly
by the triangular ligament posteriorh- sidered the patient sufiiciently progressed
by the iiedunculated, ball-valve, intravesical to allow him to leave the hospital. This
growth. The catheter inserted, now draws operation was performed January .S, 1906.
off two or more drams of urine which has The old gentleman gained rapidly in weight
collected there, by trickling around the ball, and strength, and is today about his parchand
retained by the external cut-off muscle ial vineyard. A letter dated April 9. 1909,
deceives the surgeon as to the actual length says; "My general health is good, but I
of the urethra. The ball-valve must be have been troubled considerably of recent
passed before the bladder is reached, when by the urine being thick and bloody."
a generous gush of urine signalizes the Again, cystoscopy is scientific, accurate,
cavity proper. I'urther, about the diag- pretty, interesting. But the writer would
nosis; There is only one more condition forcibly condemn any instrumentation
which can be justifiably confounded with along the urinary channels of the engorged
prostatic enlarnement— "contracture of the prostate except for positive diagnosis. It
neck of the bladder." This is an actual is in but few instances that we are unable
stenosis by fibrous tissue following a pre- to make a diagnosis when a rectal examivious
gonorrheal invasion. The retention, nation has been thoroughly carried out, the
the overflow, the frequent demands, keenly history carefully gone into and a large-size
simulate prostatic obstruction. Theyounger catheter inserted. Salol and urotropin, five
age of the patient, the previous history, grains each, three times daily, copious warectal
examination and insertion of a goodly ter drinking, the bowels well opened with
sized sound which gains the l)ladder with salts, simple diet, the bladder gently and
difficulty, if at all, settles the c|uestion. carefully irrigated with warm boric acid
The writer had recently an illustration of solution two or three times daily, a little