PROGNOSIS - ACUTE PROSTATITIS.
The prognosis of acute prostatitis in otherwise healthy subjects is quite favorable as regards the immediate recovery of the patient, whether suppuration occurs or not. As already indicated, some cases of suppuration prove fatal, this being especially true of the phlegmon ous form which occurs sometimes in young subjects, but more often in prostatiques in whom general debility is more marked on the aver age than in younger men. The local symptoms are, however, likely to be improved in this class of cases after the evacuation of the abscess.
According to Segond the prognosis of generalized prostatic phleg mon is rather grave. In 114 cases collected by this authority, there were 34 deaths, ten cases in which permanent fistula followed, and 70 recoveries. Segond's statistics are not a fair criterion of the gravity of prostatic abscess taken as a whole. In many cases, even of prostatic phlegmon, an incorrect diagnosis is made, yet the patient eventually recovers after spontaneous evacuation of the pus. In the milder cases of prostatic abscess pus very frequently discharges into the urethra and apparent cure results, the true condition of affairs being unrecog nized. It is the opinion of the author that many cases in which sub sidence of the prostatic symptoms is coincidental with a sudden and marked recurrence of the urethral discharge. come under this head.
In both young and old subjects with prostatic abscess, persistent pyuria with exacerbations of cystitis and supervene. The abscess, after evacuation into the urinary tract, instead of closing down and becoming obliterated, remains as a suppurating sac with one or more openings into the urinary canal. Decomposing urine
and products of suppurative inflammation may perpetuate this con dition of affairs indefinitely. In most cases in which abscess forms without marked follicular inflammation, the patient recovers com pletely. In the follicular form of the disease, however, and in those diffuse and suppurative forms in which follicular inflammation is the primary condition, the case is apt to become very stubborn. In the opinion of the author, no patient who had ever suffered from acute follicular prostatitis ever recovers completely. The proportion of patients who have chronic inflammation of the prostate, as a conse quence of acute follicular prostatitis of gonorrhoeal origin, is much greater than is ordinarily believed. Cases taken at random and studied upon the post-mortem table in our large cities will substan tiate the accuracy of this assertion. In a careful study of nearly two hundred prostates, taken in this way, the writer found by far the larger proportion of cases to present evidences of more or less recent inflammation, in which, in all probability, the primary condition had been one of acute follicular prostatic inflammation. Practical obser vation should convince any thinking man that a prostate, the glandu lar tissue of which is once infected, is likely to be always more or less diseased.