CYSTITIS OF OBSTRUCTION. 2. Cystitis of Obstruction.—Passing to the cystitis of obstruction, we shall find that this presents itself to our notice as chronic and sub-acute. The chronic form is usually seen in cases of enlarged prostate and in some of the commoner varieties of organic urethral stricture. The cystitis of the enlarged prostate is due, not alone to some urine remaining in the bladder, but also to the direct irritation produced by protruding masses of the hypertrophying part. This irritation leads to an excess of mucus being thrown out, and its accumulation with a residuum of urine in the most dependent portion of the viscus. The result of this is decompo sition of the urine and the evolution of ammonia. By the constant presence of such compounds the bladder becomes in flamed, intolerant of its contents, liable to slight hemorrhages, and incapable of performing its natural function with any comfort to the patient. Going a stage further on, the dilated ureters, and perhaps the pelves of the kidneys, share in these changes, and thus serious complications are almost imperceptibly added. In certain cases of stricture much the same sort of thing occurs, though for obvious rea sons the amount of the vesical mucus is not so great as in the former illustration; still it is sufficient to produce similar changes in the urine. This excretion is rendered alkaline and ammoniacal, the blad der becomes irritable, the patient is constantly straining to emit a few drops of urine, and in like manner with the cystitis of the large pros tate, the ureters and kidneys may eventually become involved.
The indications for treatment are tolerably clear. Remove the cause and the consequences will subside, either spontaneously or with the assistance that art can render. In the case of the large pros tate this cannot always be done to the extent we could desire, at all events in many of those instances where the growth has been of a steadily progressive character. The obstruction, if it cannot be re moved by operation, may be largely remedied by the judicious use of the catheter. How and when the catheter is to be used must to a large extent be left to individual experience and discretion. Where cystitis is due to chronic organic stricture, it will be found to decline spontaneously as the obstruction yields to appropriate treatment. Week by week, as dilatation proceeds, the bladder loses its irritability, and the alkaline urine, perhaps ammoniacal and charged with mucus, resumes its normal reaction and appearance. The next indication is to prevent the contents of the bladder keeping up or adding to the in flammation which has already commenced. Offensive urine and tena cious alkaline mucus are in themselves sufficient elements for the pro duction of inflammation irrespective of the obstruction in the canal. To correct this, and to remove excess of mucus, the bladder may re quire ablution, just as the nasal passages do when they are the seat of offensive oaena. These details will be referred to when I come to speak of the process of washing out the bladder.