Urethral fluxes of muco-pus are occasionally seen in cases of en larged prostate. These are due either to mechanical pressure on the organ during stool or micturition or to coexisting anterior nrethritis. In long-standing cases there may be from time to time urethral hemorrhage as a consequence of prostatic congestion. These cases are less liable to acute retention because of the conservative effect of the bleeding.
As the morbid changes increase, the patient becomes very irrita ble and testy ; slight chilly sensations and more or less fever, partic ularly during the afternoon, are not unusual. The functions of the digestive organs are apt to be more or less disturbed; the general strength is somewhat impaired, sometimes early in the case. These various symptoms are due to more or less impairment of the function of the kidneys with consequent slight urcemia, in combination with a certain degree of absorption of the products of decomposition from the urinary tract. This condition may be termed chronic urinary fever.
In the early stages of enlarged prostate the urine contains more or less mucus ; later on this is replaced by muco-pus in the form of little masses and clots, and an abundance of triple phosphates. Some times the fluid is dark from admixture with blood, particularly if calculus exists. The acidity of the urine gradually diminishes until it eventually becomes very ammoniacal and fetid.
If calculus forms in the course of the case there may be consider able pain, especially during movements involving jolting of the body, but this pain is not so marked as in cases of calculus dependent upon other causes. In ordinary cases of stone the stream of urine during micturition is apt to be suddenly checked, and coincidentally severe pain with more or less bleeding occurs during the expulsion of the last few drops of urine. In enlargement of the prostate the stone
lies passively behind the obstruction at the neck of the bladder, and as the contractility of the muscular walls of the bas fond is impaired it is not impelled against the sensitive vesical neck at the termination of micturition.
Attacks of acute cystitis may occur from time to time in the course of hypertrophy of the prostate, and are apt to lead to a fatal result through exhaustion or perhaps gangrene of the vesical mucous mem brane. Patients of a gouty or rheumatic diathesis are particularly apt to have intercurrent attacks of retention and acute inflammation.
As the foregoing symptomatology demonstrates, there is no class of patients who are more worthy of the sympathy and careful atten tion of the physician than the unfortunate victims of pronounced prostatic hypertrophy. It is indeed sad that such a large proportion of humanity should be afflicted with so harassing an affection during the declining years of life, at a time when there are so many other infirmities incidental to senility to render the life of the old man un comfortable. As a consequence of the drain upon the system pro duced by the discharge of pus from the bladder and depression of the nervous system from pain and loss of sleep in combination with the effects of general senile decline, the patient with enlarged prostate is apt to have his life considerably shortened, even if he escapes the dangers of acute retention, cystitis, and renal complications. The fact that the life of the patient will inevitably be made miserable is sufficient to warrant us in seeking radical measures of relief and adopting them at an early period when operation is comparatively safe and holds out a reasonable prospect for permanent benefit.