ANOMALIES OF THE PROSTATE.— These are among the rarest examples of defective development; they occur only in conjunction with extensive malfor mations of the adjacent urinary and genital organs.
Wounds of the Prostate.
Symptoms.—These will depend upon the nature of the injury. Wounds of the prostate complicating injuries to the perineum or rectum will be accompanied by the usual symptoms attending lacer ated wounds in general. If the urethra is lacerated also, there will probably be retention of urine or extravasation at the point of injury; or retention may result from swelling of the gland, simply, without injury of the urethra. Infection of the wound will give rise to a diffuse inflammation, or, what is more serious, to phlebitis of the prostatic plexus, which is very prone to cause septicremia or pymmia. The extravasa tion of urine is apt to involve either the perineum or the prevesical space; in the latter case, if not checked by prompt in cision and drainage, the extravasation will involve the areolar tissue of the ab domen, thighs, penis, and scrotum.
Wounds of the prostate caused by the unskillful use of catheters will be fol lowed by haemorrhage, probably by re tention, and in some instances by in flammation of the gland.
The constitutional symptoms will de pend upon the nature of the local condi tidn. Profuse hfemorrhage will cause a blanched skin, pallid lips, subnormal temperature, and a rapid, thready pulse. Inflammation will he accompanied by se vere local pain, frequently throbbing in character; fever, and acceleration of the pulse. Infection of the wound will have superadded to the symptoms of inflam mation a higher and more irregular type of fever, and possibly chills. Infectious phlebitis is very apt to be accompanied by chills and pronounced constitutional symptoms.
Etiology. — Wounds of the prostate are of rare occurrence, by reason of the protected situation of the gland. Lacer ated wounds of the perineum or rectum caused by the individual being impaled on some pointed object may also in volve the prostate. It may be injured
in rare cases of extensive fracture of the pelvic bones. The prostate is wounded in puncturing the bladder with a tro car from the perineum, and it may be in carrying out the same procedure through the rectum; and, when en larged, it has been wounded by injudi cious attempts to pass a metal instru ment through the urethra into the blad der. It is always cut in performing perineal eystotomy.
Treatment.—The first requisite is rest. The patient should be confined to bed. Wounds of the perineum involving the prostate require the same treatment as is appropriate for lacerated wounds else where. Foreign bodies should be re moved, bleeding vessels ligated, the sur faces cleansed as thoroughly as possible, and drainage provided for. Frequently no ligatures will be required, inasmuch as the use of a tampon of iodoform gauze will serve the double purpose of arresting the bleeding and securing drainage. If the wound of the prostate be extensive, it is advisable to introduce a catheter into the bladder through the urethra and to retain it, inasmuch as the subsequent inflammatory swelling may cause retention and the introduction of the catheter at this time would be both more difficult and more painful. If the urethra or neck of the bladder has been opened by the accident, it is particularly important to employ the retained cath eter. If it is impossible to introduce the catheter on account of laceration of the urethra, a perineal section should be made for the purpose of introducing the catheter. It may then be placed through the perineal wound, or, prefer ably, through the entire urethra. If bleeding has occurred backward into the bladder, copious irrigations of warm, boric-acid solution through the bladder should be employed. If the catheter be comes occluded by clots, they may be dislodged by making suction with the syringe or by injecting a little of the boric-acid solution.