VARIETIES - ACUTE PROSTATITIS.
Acute prostatitis presents itself in several forms according to the method of causation and the structures to which the acute inflamma tion is mainly localized. Without the slightest disposition to be dog matic in the matter of classification, the author inclines to the view that from a clinical standpoint the following forms of acute prostatitis are capable of a clinical differentiation which is of vital importance in the study and management of such cases.
A. Follicular or parenchymatous prostatitis, having its point of de parture in a posterior urethritis due to extension or transference of infection to the deep urethra.
B. Diffuse prostatitis, usually presenting itself as a consequence of extension of the acute follicular form. It may, however, occur as a primary condition. The presence and degree of interstitial inflam mation in the diffuse form of the disease depend upon the method of causation, i.e., whether it is due to traumatism, to extension, or to lymphatic infection. This may be associated with localized or dis seminated pyogenic infection.
C. Prostatitis with Circumscribed Suppuration.—Acute suppurative prostatitis, due to extension of urethral inflammation, infection from local absorption, or infection through the lymphatics or the blood vessels.
D. Prostatitis with Disseminated Foci, of Suppuration (Miliary Ab scesses).—In all forms of prostatitis associated with suppuration more or less diffuse interstitial inflammation is invariably present.
E. Para-prostatitis.—This is usually but not necessarily followed by abscess, and is associated with one or the other of the foregoing forms.
The basis for classification A is due to the belief of the author that the most important ultimate anatomical element of the prostate is the secreting glandular tissue. According to this view the glands, ducts, and follicles of the organ constitute the true parenchyma. The acute follicular or parenchymatous form of the disease embraces most of the cases of so-called acute posterior urethritis, and varies in se verity from an involvement of the follicles alone to that of all the secreting structures of the organ. Indeed, it is the opinion of the author that the acute inflammation of the prostatic urethra in these cases is relatively unimportant in the pathological ensemble, save as the point of departure of the prostatic inflammation. Most of these
cases should be classified as acute follicular or parenchymatous pros tatitis. In practically all, if not actually in all, of the cases of so-called acute posterior urethritis from gonorrhoea or other source of mixed in fection, the inflammation of the mucous membrane of the deep urethra is but a small part of the morbid condition resulting from such in fection. The author cannot conceive of an acute inflammation of infectious origin which limits itself to the mucous membrane of the posterior urethra. A few subacute and chronic cases possibly are met with in which the bulbo-membranous region is involved without ex tension or transference to the prostatic urethra. It is the belief of the writer, however, that in all cases, whether acute or chronic, in which the prostatic portion of the urethra is involved, the glandular elements of the prostate become affected sooner or later. In acute cases of inflammation extending beyond the bulbo-membranous junction, the author does not believe that the glandular elements of the prostate can possibly escape involvement. It is certainly open to argument whether or not the consideration of so-called posterior urethritis as an acute or chronic follicular inflammation of the prostate, rather than a disease of the urethra per se, might not be of great practical clinical importance, as explaining the extreme obstinacy of the disease and the impossibility of curing it completely by applications to the small and unimportant infected area presented by the mucous membrane lining the prostatic urethra. Looking at posterior ure thritis from this standpoint, the question might arise whether deep injections of astringents may not defeat the very object which the practitioner strives to attain in such cases, by impeding drainage from the glandular elements and ducts of the prostate constituting the principal seat of the infectious inflammation. Associated with these cases there is usually more or less involvement of the inter stitial tissue surrounding the ducts and glands of the organ, the resulting mechanical conditions depending entirely upon the degree of involvement.