PROSTATE - EXAMINATION OF THE PATIENT FOR THE SOURCE OF HEMATURIA OR HAEMATURIA.
The prostate should be mapped out with the finger into its two lobes and the intervening sulcns. Dense localized hardness of the adult prostate is due to the presence either of tubercular deposit or of stones which have replaced the prostatic tissue. There is rarely much difficulty in distinguishing between the two. The tubercular deposit occurs most often as a small projection the size of a monkey nut situated in one or other of the lateral lobes. The corresponding epididymis in many cases is affected previously. It is stated that the prostate lobes are shotty in cases of tubercle of this organ. The many-small-shot-like feel is much rarer than the defined mass.
Prostatic calculi which can be felt per rectum are always multiple and can be made usually to grate on one another. They are, more over, much harder than the tubercular deposit.
At or about the age of fifty the prostate may take on carcinoma tous degeneration or enlarge from senile changes toward the rectum or bladder or both. Carcinoma is usually detected at once by the irregular, dense, diffused stone-like feel of the gland; senile changes invariably exhibit a uniform enlargement and more or less elastic re sistance to the finger. It should be remembered that a full bladder in the stooping posture flattens the prostate and gives it a fictitious hardness.
It is wise at this time to examine the bladder bimanually, the pa tient being still in the knee-and-elbow position; the fingers of the left hand are placed on the pubes and an attempt is made to approxi mate them to the finger in the rectum or vagina. By this means any pronounced hard growth in the bladder from the lateral wall or apex may be recognized.