SYMPTOMS - CHRONIC PARENCHYMATOUS PROSTATITIS.
Chronic Parenchymatous Prostatitis. —The patient usually gives a history of a more or less recent attack of gonorrhoea with complicat ing deep-seated inflammation which has been referred to the posterior urethra, bladder, or prostate, according to the notion of the physi cian who has happened to have the case in hand. There is often a hiStory of complicating epididymitis which is sometimes in itself an evidence of prostate-urethral inflammation. The symptoms of irri tation of the vesical neck characteristic of follicular or parenchyma tous prostatitis may have subsided and the patient may assert that he had been perfectly well for some little time, a relapse having been brought on by indiscretion or exposure to cold. On careful ques tioning, however, it will be found that slight symptoms referable to the neck of the bladder and the region of the prostate, consisting of more or less weight, voluptuous sensations with slight increase in the frequency of micturition, and in a general way symptoms of hyperms thesia of the prostatic urethra have persisted since the original acute attack of inflammation. In other instances the patient gives a his tory of continuous vesical irritation of greater or less degree of severity since the primary involvement of the prostatic urethra. The principal symptoms of which patients complain are frequency of mic turition, with more or less pain and perhaps a slight quantity of blood at the termination of the act as the deep perineal muscles con tract upon the tender prostate. The urinary symptoms in general are not imlike those of vesical calculus. The sexual function is more or less disturbed. Nocturnal pollutions, premature and perhaps painful ejaculations may exist. The seminal discharges may be mixed with a greater or less quantity of blood. This is especially apt to be the case if the seminal vesicles be involved. A sensation of fulness perhaps with a tinge of voluptuousness in the perineum, itch ing and tickling sensations in the perineum, urethra, anus, and rec tum are often met with. The 'patient may be annoyed by frequent and persistent erections, and excessive sexual desire may exist. Pa tients are quite likely to go to the other extreme and complain of complete loss of sexual appetite and of inability to perform the sexual act. More or less congestion or inflammation of the anterior urethra may be present, as a consequence either of simple irritation and cir culatory disturbance, or of infection from the deeper portion of the canal; as a result there is more or less oozing of muco-purulent discharge from the meatus. This muco-purulent discharge is more
profuse during defmcation and at the end of micturition, and may be noticeable only at such times. It is to be distinctly understood that whenever discharge appears from the meatus during the intervals of micturition and defecation some morbid condition of the anterior ure thra necessarily exists. More or less backache with neuralgic pains along the spermatic cord, in the testes, groins, thighs, and radiating into the urethra may exist. The patient is quite likely to complain of a pain located an inch or so behind the meatus on the under surface of the urethra. This pain is apt to be misleading both to the patient and practitioner, and is very similar to that which is experienced in vesical calculus. The mind of the patient is rarely tranquil, and_he is usually imbued with the idea that he has spermatorrhcea, as might naturally be expected. The discharge may contain spermato zoa where the stool is difficult and much pressure is brought to bear upon the seminal vesicles. As a rule, however, it is muco-purulent in character and is composed of pus, mucus, and fatty detritus with more or less epithelium. Where the vesical neck is profoundly implicated, the peculiar ovoid epithelium characteristic of this location is apt to be found.
The urine contains muco-pus and epithelium, the characters vary ing with the degree of posterior urethritis present. The so-called Tripperfaden and the peculiar horseshoe-nail-shaped filaments or flocculi characteristic of inflammation of the prostatic follicles are usually found. Exercise increases the symptoms; there is more or less discomfort attending the act of defrecation, and the patient is very likely to apply for relief for rectal and anal disease, his symptoms being almost altogether referable to this region. If, as may be the case, the prostatic trouble be complicated by piles, fissures, or fistula, an erroneous diagnosis is quite likely to be made; especially is there an interdependence between the condition of the prostate and that of the ano-rectal region. The writer has at present under observation a patient who states that there is a very peculiar oscillation in his symptoms. When the symptoms referable to the neck of the bladder and prostate are most severe there is less discomfort in the region of the rectum, and vice versa.