SYMPTOMS - ACUTE PROSTATITIS.
In the follicular form of acute prostatitis the symptoms are mainly subjective. Frequent and painful urination, pain being especially marked at the termination of the act, and in some cases the escape of a certain amount of blood with the last few drops of urine consti tute the principal local symptoms. A feeling of distress in the peri neum with pain radiating along the urethra into the spermatic cords or down the inner aspect of the thighs, is frequently experienced. In some cases there is more or less pain and tenesmus referable to the rectum. The stools are likely to be somewhat painful. There may be considerable constitutional disturbance, but as a rule this is very slight, if present at all, excepting where there is a greater or less degree of diffuse inflammation. In the diffuse form of inflam mation and in the varieties in which pus formation occurs, there is more or less obstruction to the flow of urine. Complete retention may come on and persist until such time as the abscess evacuates itself or has been opened, when speedy relief of the symptoms occurs. When pathogenic infection of the prostate occurs independently of preceding follicular inflammation, there may be comparatively little irritation about the vesical neck, the symptoms of urinary obstruction preponderating. This is especially apt to be the case in those acute forms of abscess which come on in the course of prostatic hyper trophy. In the diffuse and suppurative forms of prostatitis, the pain and constitutional symptoms are especially marked. Profound de pression is likely to be present, and in prostatiques especially the patient may sink into a typhoid state and die with all of the symp toms of constitutional pyogenic infection. True Pymmia may result as a consequence of a localized suppuration. The formation of pus is likely to be heralded by a distinct chill. In some cases a succes sion of chills may occur. In some cases of acute prostatitis the dis ease develops very suddenly. In some instances a few hours, or pos sibly several days, may elapse before the symptoms become prominent. During this period the patient experiences premonitory sensations of weight and fulness in the perineum, with frequent micturition and a certain degree of depression incidental to the irritation of the vesical neck. In cases in which abscess forms severe throbbing pain is likely to come on. This may be of a lancinating rather than of a throbbing Character, radiating, as already stated, into the urethra, groins, and thighs. The slightest exercise tends to aggravate the symptoms. The patient very often finds quite early in the course of the disease that slight perineal pressure gives rise to considerable pain and tenderness, and possibly vesical irritability.
According to Thompson, cystitis is likely to coexist with acute prostatitis, but in the opinion of the author this is quite rare, all of the symptoms being explicable by the involvement of the prostatic urethra. In cases having their point of departure in follicular inflam mation, the urine contains muco-pus derived from two sources : First, that which is directly washed out of the prostatic. urethra by the out flowing urine; Second, that which has taken the direction of least re sistance and escaped back into the bladder during the intervals of micturition. The first and last portions of the urine in cases of fol licular inflammation are likely to contain considerable muco-pus, the mid-stream of urine being comparatively clear. In cases in which there is no follicular inflammation, the condition being primarily one of diffuse inflammation, or of localized inflammation incidental to infection and followed by suppuration, the urine contains nothing characteristic until such time as the abscess ruptures into the urethra or bladder. In these cases the patient experiences a sudden feeling of relief in the perineum and ano-rectal region, the urine flows with perhaps its usual freedom, or at least much more easily than before the rupture of the abscess, and pus suddenly appears in the urine. It does not escape from the urethra during tho intervals of micturition unless secondary infection of the anterior urethral mucous membrane occurs, or unless the point of rupture is located anterior to the bulbo membranous junction.
The objective symptoms of acute prostatitis vary with the degree of diffuse inflammation. Where the pathological process is largely of a follicular character, as in a certain proportion of cases of so-called posterior urethritis, local examination elicits very little save more or less tenderness on deep perineal pressure and on manipulation of the membranous and prostatic portions of the urethra per rectum. Deep pressure behind the pubes may elicit a certain degree of tenderness referable to the vesical neck. In the more severe types of diffuse and circumscribed suppurative inflammation more or less heat, swel ling, tension, and tenderness of the perineum are noticeable. The prostate presents itself as a hot, tender tumor projecting into the rec tum antero-posteriorly. The degree of enlargement varies with the extent of interstitial inflammation, and may be so marked that ihe fin ger cannot be introduced into the rectum without considerable diffi culty and the production of very severe pain. When suppuration has occurred a boggy, oedematous, uniform, or circumscribed bulging of the prostate and peri-prostatic tissues into the rectum is noticeable.