Wounds of the prostate caused by fracture of the pelvis must be treated upon general principles in addition to the measures required for the other com plications. If the urethra be lacerated a permanent catheter must be intro duced, cutting down, if necessary, upon the point of laceration in order to pass the catheter into the bladder. The treatment of rupture of the bladder will be described under diseases of this vis cus. Injuries of the prostate resulting from forced catheterization, if slight, recover spontaneously; if more severe, they require the use of the permanent catheter to provide against retention from swelling; and the use of urinary antiseptics and copious draughts of water, perhaps also the administration of mild sedatives.
Wounds caused in performing peri nea' cystotomy do not require any spe cial attention.
In the care of wounds of the prostate from external causes frequent irrigations with antiseptic solutions and particular attention to all of the antiseptic details are desirable in order to limit as much as possible the extent of the inflammatory reaction. Careful attention to these de tails may frequently spare the patient the dangers accompanying septic inflam mation of the prostatic plexus of veins.
All injuries of the urethra or bladder require the internal administration of urinary antiseptics.
Foreign Bodies in the Prostate.
and tenderness in the perineum and a frequent or almost constant desire to urinate, the act being accompanied by severe pain, are the prominent symptoms. By rectal exami nation the gland will be found somewhat swelled, unduly tense, and tender to the ! touch. Softening or fluctuation would indicate the formation of an abscess.
ETIOLOGY.—Vesical calculi, when of small size, may lodge in the prostatic urethra. Occasionally during the intro duction of an old catheter a portion will break off at the point and remain be hind. Cases are also sometimes met with in which foreign bodies in the pros tate have been introduced into the ure thra, and, having passed beyond reach, have lodged in the prostate.
-In some instances these bodies may be removed through the ure thra by the urethral forceps. This is particularly the case of the small calculi that become impacted here. Bodies that cannot be thus removed should be taken out through a median incision. If sup puration should supervene, the abscess should be treated according to the gen eral principles applying to treatment of abscesses elsewhere.
Acute Prostatitis.
This occurs in two forms: the follicu lar and the parenchymatous. The for mer is much more frequently met with than the latter.
Symptoms.—These vary greatly in de gree, probably owing to the nature and virulence of the infection. In the mild est form of the follicular variety there is a sense of heat and fullness in the peri neum, with some increased frequency of urination, which is attended with more or less pain. In the more marked cases
the same symptoms exist in a much ex aggerated degree; the fullness is re placed by severe pain, urination may be very frequent and painful and accom panied with considerable tenesmus, or there may be complete retention. On account of the sensitiveness of the gland, sitting may give rise to consider able pain, and digital examination of the prostate through the rectum will show that the organ is probably larger than normal and distinctly more tender to pressure.
The parenchymatous form, in which all of the structures of the prostate are involved, is accompanied by more severe symptoms than the follicular variety. The pain is more marked, and fre quently of a throbbing character. The frequent urination and tenesmus are greater, or more probably there will be retention from the extent of the swell ing. In the follicular variety there is usually a moderate degree of fever with a corresponding acceleration of the pulse. The parenchymatous form is apt to cause a higher temperature and is accompanied by marked constitutional symptoms, not infrequently with chills.
The usual history is that, following a urethritis, the train of symptoms above mentioned develop more or less sud denly. This should always excite sus picion of a prostatic complication. It is to be distinguished from acute cystitis, in which the frequent and painful uri nations are more pronounced, while the complaints connected with the perineum and rectum are proportionately less. In flammation of Cowper's glands gives rise to symptoms confined solely to the per ineum. There will be no symptoms referable to the prostate. In all cases the digital examination of the prostate will be the final test by which to deter mine whether it be inflamed or not.
Etiology.—In the vast majority of cases inflammation of the prostate is due to infection from a posterior ure thritis. A number of other factors are mentioned as giving rise to prostatitis. Traumatism is probably one of the rarest of these. Exposure to conditions which cause internal congestions which are usually described as a "cold" is a more common cause. Occasionally the pres ence of a calculus in the prostatic urethra or other form of foreign body will excite inflammation. The excessive use of can tharides will in some instances have the same effect, as may also the use of irri tating injections or of strong chemicals in the deep urethra. All of these con ditions probably act by establishing a favorable soil for the reception and development of micro-organisms. Evi dence is lacking to show that horseback riding and bicycle-riding are productive of injurious effects if proper saddles be selected.