When a prostatic or peri-prostatic abscess is opened from the rec tum, or discharges spontaneously into the gut, extensive infection with the formation of ischio-rectal abscess and external fistula or a permanent internal fistula may result. In all cases in which the abscess has been evacuated into the rectum, careful antiseptic irriga tion is necessary. Care should be taken, however, to avoid poison ing the patient by too strong antiseptic solutions. Carbolic acid and the bichloride of mercury are particularly open to impeachment on this score. A saturated solution of boric acid is much safer, al though necessarily not so efficient. It may become necessary to divulse the sphincter ani to relieve rectal tenesmus or secure perfect drainage. By putting the sphincter at rest, it may be possible to induce healing without the necessity of more serious operative pro cedures. In the event, however, that a permanent fistula results, it should be dealt with as in ordinary cases of ano-rectal fistula. When the abscess ruptures, or is evacuated by the perineal route, there is danger of permanent urinary fistula. When the pus is evacuated in the direction of the urethra, the repeated formation of peri-urethral abscesses may eventually result in the formation of a perineal fistula. When the pus is external to the prostate in the para-prostatic tissue, there is less danger of infiltration of urine and urinary fistula than in cases in which the prostate proper is involved.
General supportive measures and possibly the administration of stimulants may be necessary after the evacuation of a prostatic abscess. This course should be invariably adopted in cases of pros
tatic abscess in ivostatiques. Should pyremia occur in the course of prostatic abscess, it is likely to be in old cachectic and debilitated sub jects, and death is practically inevitable. In cases in which retention occurs from prostatic inflammation or abscess, especially in old sub jects, it may be impossible to evacuate the urine with the ordinary form of catheter. The catheter coude of Mercier may be introduced much more readily than the ordinary form of catheter. A soft Ma ton catheter is, in the experience of the author, often unsatisfactory. In passing the elbowed catheter the superior urethral wall is so closely hugged that there is comparatively little danger of penetrating the abscess cavity with the instrument. Instances have been known where the abscess cavity has thus been penetrated and was taken for the bladder. The important fact is to be remembered that it is far better to evacuate an abscess by an external incision than to produce an internal opening into the urethra or to allow such an opening to occur spontaneously. It is admitted that in many cases in which the abscess opens in the direction of the urethra, the patient recovers speedily and completely, but in a certain proportion of cases perma nent infection results with all the dangers of urethritis, cystitis, and recurrent prostatic abscesses.