Tn catheterizing patients who have en larged prostates more or less difficulty is frequently experienced as the instrument reaches the prostatic urethra. For this reason it will be necessary in some in stances to try different forms of cath eters. The elbowed catheter is one of the most useful in difficult cases, and the metal prostatic catheter, which has a longer shaft and a larger curve, will sometimes pass easily when all other forms are arrested. It should be an in variable rule to use thorough asepsis in all of the urethral instrumentation, in order not to induce cystitis.
When catheterizing in hypertrophy of the prostate gland, the soft catheter with solid tip is the best to use if possible. If a rigid one be required, one made of elastic webbing, with a curve or bend at the point, is preferable. A new catheter must be treated with the same care as to cleanliness and asepsis as one that has been in use. If possible, it should be ex posed to the vapor of formaldehyde; if not, it should be immersed in a solution of formalin (1 to 2 per cent.) during at least fifteen minutes. Then it should be placed in a strip of bichloride gauze, or placed between the folds of a perfectly clean towel. Each catheter should be kept in a separate receptacle or closed drawer, where dust cannot find access to it, and where it cannot be handled except by the person who is to use it. If the pa tient must carry the instrument about with him, it should be kept wrapped in several layers of bichloride gauze, and outside this should be placed a wrapping , of "waxed" or parchment paper, held firmly by rubber bands. Just before using the catheter the patient must thor oughly clean his hands, and rinse his fingers in pure alcohol. In the meantime the catheter should be lying in formalin solution. Then. after shaking it, and wiping off any drops that may remain upon it with a piece of clean gauze, and smearing it with a proper lubricant, the patient should gently pass it along the urethra. Immediately after use the catheter should be thoroughly washed with soap and water, be steeped for a time in the solution of forma lin. and thou carefully put away in gauze or clean towel. Bangs (Med. News, Feb. 12, '98).
The faradic current is more health fully stimulating to the prostate than the mechanical method of massage. In acute eases it lessens hypertrophy. and cures the weakness of the compressor muscles. Moritz Popper (Wien. med.
Blatt., Jan. 20, '09).
The cause of the usual form of prostatie enlargement and of certain forms of prostatic atrophy is a slow formation of new connective tissue due to infection or to infection aggra vating a senile degenerative process. The gonococcus: is probably most often the specific infection, because (a) of its great frequency; (b) other inflammatory causes are not common in the parts in question ; (c) a great similarity exists between the histology of gonorrheal processes and those seen in these senile prostates. Neoplasms, fibromyomata. and adenoma occur, but may be called rare. Crandon (Annals of Surg., Dee. 5, 1902).
Operative Treatment.—Of the opera tive procedures which have been recom mended for enlarged prostate, those which seem to-day to deserve mention are: (1) vasectomy; (2) castration; (3) Bottini's operation; (4) cystotomy, for drainage, either perineal or suprapubic; (5) prostatectomy.
VAsEcromY, which grew out of the operation of castration, recommended by White in 1S93, is distinctly the mildest of the various operative procedures em ployed in the treatment of hypertrophy of the prostate. In spite of the apparent insignificance of this operation, it has been followed by a small mortality. This is to be explained by the condition of the patients at the time of operation. They are all persons in advanced years who have suffered from chronic obstruc tion for some time, and who, in conse quence, are apt to have cystitis, dilated ureters, and kidneys. Even the introduction of a catheter in some of these cases is followed by fatal quences. Statistics show that relief.
more or less pronounced, follows tomy in about GO per cent. of the cases, in some of which the conditions seem to return approximately to the normal.
This operation is to be recommended after the various methods of palliative treatment have failed to give relief.
Such patients usually have a moderate degree of enlargement, several ounces of residual urine, and the difficulty or pain caused by passing a catheter is so great as to demand some other form of ment. If in addition to these the pa tient is old and feeble, and if it seems probable that he would not stand a more severe operation, vasectomy should be performed. If this fails to give relief one of the other operations may be per formed later.