VARIETIES - HYPERTROPHY OF THE PROSTATE.
Hypertrophy of the prostate presents itself in several different forms, depending mainly upon the arrangement of the elements com posing the abnormal growth. It is occasionally associated with athe romatous degeneration and thickening of the walls of the bladder, the prostate being diffusely enlarged and the anatomical characters of the bladder changes and prostatic overgrowth being approximately the same. In a general way, the varieties are as follows : 1. Diffuse enlargement of the gland associated with a.theroma of the bladder. Exceptionally, circumscribed development of the pos terior median or one of the other lateral lobes may be associated with vesical atheroma. As a rule, however, where vesical atheroma is found, the prostate is uniformly enlarged. In this variety the thick ening of the bladder, especially that portion immediately contiguous to the prostate, is likely to be considerable, the vasa deferentia, seminal vesicles and possibly the ureters, participating in the athero matous process, the connective tissue enveloping these structures being greatly thickened by the atheromatous deposit, producing a gristly or semi-cartilaginous condition of the tissues. Rigid columns of atheromatous tissue are likely to project into the bladder. In some instances columns of this sort correspond to the course of the ureters and vasa deferentia. A bar between the ureteral orifices is common in this condition.
2. Diffuse enlargement without atheroma, of the bladder.
3. Hypertrophy of both lateral lobes, the median portion of the prostate remaining comparatively normal.
4. Hypertrophy of both lateral lobes associated with posterior median hypertrophy, so-called hypertrophy of the middle lobe.
5. Hypertrophy of one lateral lobe associated with posterior median hypertrophy.
6. Posterior median hypertrophy with little or no enlargement of the rest of the organ. The overgrowth may present a quite acute prominence in the median line or may be more or less irregular, filling up the vesico-urethral orifice and projecting to one or the other side.
7. Hypertrophy of the anterior portion of the prostatic floor. This may or may not be associated with hypertrophy of one or both lateral lobes. The latter is most frequent.
8. Some form of prostatic hypertrophy associated with bar at the neck of the bladder.
9. Distinct circumscribed fibro-adenomatous tumors occurring in some part of the gland. These are somewhat analogous to the fibro myomatous neoplasms which develop in the uterus. When these new growths occur in the floor of the prostatic urethra they may form quite distinct pedunculated tumors. In some instances they project from the posterior median portion into the bladder and act after the manner of a ball valve in producing urinary obstruction.
When the prostate is diffusely enlarged the mass may not cause so much difficulty, even when it is very large, as is produced by irregular development associated with deviation of the prostatic urethra and obstruction of the vesical neck. It seems that it is not the degree but the variety of enlargement which is most important. A very large gland may sometimes be tolerated, while a very small median obstruction often gives rise to great annoyance. It is prob able that in many cases of prostatic hypertrophy the process is at the beginning of an adenomatous character, affecting the glandular structures of the organ. As the process advances fibro-sclerotic changes develop and eventually the enlargement appears in the form of a fibro-adenomatous development. In all the varieties of pros tatic hypertrophy it is probable that there is not only hypertrophy of the elements of the organ but a true hyperplasia, which primarily at least is the predominating condition. It is a serious question as to whether the process should not be termed hyperplasia rather than hypertrophy of the prostate. Certainly the increase in bulk is due more especially to an increase of the normal tissue elements rather than to an exaggerated development.