MORBID ANATOMY - ACUTE PROSTATITIS.
Comparatively little is known of the early stages of acute prostatic inflammation, especially of the follicular or parenchymatous form. The condition is not a fatal one and the opportunities for observation are consequently not numerous. As far as determined, however, the process appears to be at first limited chiefly to the mucous membrane, the follicles, and the glands immediately tributary to the prostatic urethra; hence a description of the morbid anatomy of acute follicular prostatitis is also that of acute posterior urethritis. In the follicular form there is always a varying degree of involvement of the interstitial tissue, largely dependent upon the duration of the diseaSe. It is the author's opinion that the infectious inflammation never limits itself to the prostatic urethra alone; if the inflammation does not extend below the membranous urethra, it may possibly become limited if it be not too acute in character. In acute bulbo-membranous inflam mation, however, the prostatic urethra is almost inevitably involved sooner or later. The mucous membrane of the prostate is reddened and thickened, as is true of the mucous membranes in all situations • under the influence of inflammation. There is almost invariably some thickening of the tissues surrounding the lymphatics and blood vessels.
Ulceration does not occur, and resulting stricture is so exceedingly rare that it is hardly to be taken into consideration. The mouths of the prostatic and ejaculatory ducts are involved in the inflammation, thus serving to explain the facility with which the inflammation ex tends to the glandular tissues of the organ. In acute parenchymatous or follicular prostatitis the organ is swollen according to the degree of circulatory disturbance and peri-glandular swelling.
If the process extends to the inter-glandular, muscular, and peri prostatic tissues we have the diffuse form of inflammation as accepted by the writer; corresponding to the parenchymatous form de scribed by Thompson. The organ is swollen in some cases to three or four times its natural size. The veins of the prostatic plexus are distended by dark blood. The arterial vascular supply is also en gorged. The mucous membrane of the prostate is of a darker red than usual. Pressure causes the exudation of a cloudy, reddish fluid containing blood from the engorged capillaries and venules, inflamma tory lymph, and fluid from the prostatic glands, with a small quantity of pus. Brissaud and Segond give a very clear description of the pathological anatomy of acute diffuse prostatitis, as observed in a man who died from a complicating pleuro-pneumonia. The glandular tubes were the seat of inflammation of a degree of intensity which was variable at different points. The internal wall of the ducts at points where the inflammation was most intense appeared to be blended with the muscular tissue by areas of inflammatory exudate. The inequality of the inflammatory process was especially noticeable.
In different places, notably at the periphery of the organ, marked pathological changes in some of the glandular tissues coexisted with a perfectly healthy condition of neighboring glands and ducts. The epithelium lining the glandular culs-cle-sac and ducts was replaced by an agglomeration of new tissue elements, often filling the ampullae of the glands completely. In some instances the degenerative changes had obliterated the normal glandular outlines.
Suppuration presents itself under several forms. In the follicular form the suppuration is similar to that which occurs in gonorrhoea or urethritis, the pathological condition from which the process in the prostate was originally derived. Circumscribed abscess may form in the follicular form of acute prostatitis. One or more glands become infected, and incidentally their ducts are involved. Occlu sion of the lumen of the latter may occur, as a consequence of which a suppurating cyst-like accumulation of pus results. One or more of these purulent accumulations may rupture and contaminate the re mainder of the gland. Such abscesses are often responsible for re current infection. Miliary abscesses may result from acute suppura tion. They are single or multiple and more or less disseminated. Large abscesses may be found in some cases. Abscess may occur in the cellular tissue surrounding the prostate—peri-prostatic abscess. Some prostatic abscesses are very large. Guy on exhibited a speci men in which the urethra was completely dissected out of the pros tate and was entirely surrounded by pus. Abscess cavities are gen erally multilocular and trabeculated. These abscesses may open into the urethra by one or numerous openings.
Lallemand many years ago called attention to the fact that in acute prostatitis the ejaculatory ducts may be dilated and thickened from involvement of the mucous membrane. They may be ulcerated or their lumen diminished, or in extreme cases even occluded. The seminal vesicles may be thickened, dilated, and contain reddish or puro-sanguinolent fluid. Regarding the accuracy of Lallemand's ob servations, a certain element of doubt is warrantable, because a large proportion of his patients were subjected to treatment by the ports caustique, which in itself was not only likely to set up acute prostati tis, but was very likely to be followed by occlusion of the ejaculatory ducts.
In some cases of suppuration the entire glandulo-muscular struc ture of the prostate is destroyed, as in the case outlined by Guyon. A case of this kind came under the observation of the author. The prostate was practically replaced by a suppurating cavity with quite thick walls, representing apparently the capsule of the prostate in conjunction with inflammatory new growth. The specimen was so damaged in removal, however, that it was impossible to obtain a clear idea of the relation of the urethra to the abscess.