TREATMENT - CHRONIC PROSTATITIS.
In the follicular or parenchymatous form of chronic prostatitis, the case is to be regarded essentially as one of infection of the mu cous membrane of the prostatic urethra, and of the epithelium lining the ducts and follicles of the organ. Its treatment is that of so-called posterior urethritis. It is to be remembered, however, that iu some instances the mucous membrane of the prostatic urethra becomes comparatively healthy while the infectious process or its results in the glandular structures of the organ persist indefinitely. By regard ing the condition as a chronic follicular prostatitis rather than a pos terior urethritis, the disease is likely to be treated upon more logical principles than at the hands of those who believe in an infectious process limiting itself to the posterior or prostatic urethra alone.
The therapeutics of the disease may be divided for consideration into: The general treatment comprises careful attention to genito-uri nary hygiene, with especial reference to the regulation of the sexual functions, and the administration of certain remedies having more or less marked special action upon the prostate and the mucous mem brane of the genito-urinary tract. There is little hope of securing much benefit from treatment unless the patient leads a life of conti nence and dietetic abstemiousness.
While from a pathological standpoint a perfect cure of chronic prostatitis rarely if ever occurs, the patient in a large proportion of cases may become practically well, if due consideration be paid to the time element in treatment and judicious instruction in genito urinary and sexual hygiene be given and conscientiously followed. Dilatation of the prostate by means of the steel sound is curative in a certain proportion of cases in which the inflammation is chiefly parenchymatous or follicular. Caution is necessary in selecting the time for beginning the application of the sound. It is likely to be injurious before the primary acute inflammation has entirely sub sided. It is by no means unusual for the early use of the sound to excite a recurrence of acute prostatic inflammation. Should stricture of the anterior portion of the canal exist, urethrotomy is usually in dicated. Strictures at or near the meatus are especially liable to aggravate prostatic inflammation on account of the reflex irritation and thereby excited in the deep urethra and its muscular environment. The first indication, therefore, in cases of this kind, is
to free the anterior urethra of all points of irritation and contraction. Many cases of chronic prostatitis previously rebellious to all meas ures of treatment will yield very speedily after an anterior internal urethrotomy. The results of the operation in these cases are ex tremely gratifying. The author desires to call particular attention to this feature of certain cases of chronic prostatitis.
Inasmuch as in a majority of cases of chronic prostatic inflamma tion there exists, either primarily or secondarily, infectious inflam mation of the prostatic urethra and the glands and ducts tributary to it, antiseptic treatment in some form is indicated. Internal medica tion by means of eucalyptus and the various balsamic preparations aids somewhat in antisepsis of the prostatic urethra, but more direct measures are usually necessary to accomplish the desired result. Where it is possible to employ it, deep irrigation by means of a short urethral nozzle is best for this purpose. In by far the majority of patients, after a little training, water can be readily forced from the anterior into the deep urethra and bladder without the aid of either catheter or irrigating tube. In this manner alone can the urethra and bladder be thoroughly irrigated by antiseptic solutions. There are but three remedies which are likely to prove effectual by irriga tion. These in the order of their efficiency are, in the experience of the author, first, permanganate of potassium; second, nitrate of sil ver; third, bichloride of mercury. Permanganate of potassium may be used in the strength of from 1 in 10,000 to 1 in 5,000, rarely stronger. The water should be comfortably warm, not very hot, as it is often used, and should be employed in a quantity of not less than two quarts at each irrigation. In the larger proportion of cases the permanganate of potassium is quite effectual. Sometimes, how ever, it has little effect, in which event the nitrate of silver in weak solutions often acts admirably. The solutions ordinarily recommended are too strong. From one-half to one per cent is usually quite as concentrated as the urethra and bladder will tolerate. It is worthy of remark that a half-per-cent solution by means of copious irrigation excites more pronounced reaction in the deep urethra and bladder than do much stronger solutions used by instillation.