BOTTINI'S OPERATION.—This method of treatment has recently been revived, and with the improved instrument is doubtless destined to meet the require ments in certain cases better than any other. It would seem particularly suited to the cases in which there is a distinct bar at the neck of the bladder. The operation is carried out by means of a prostatotome which is constructed some what on the principle of a lithotrite. What would correspond to the male blade, however, has at the extremity a platinum-wire loop which is heated by means of an electric current. After the instrument has been introduced the blades are turned in the direction in which it is desired to make the section of the prostate, the current gently turned on, and the wire loop made to cut through the obstructing mass by means of a screw which is attached to the handle. A second and a third section may be made if it is thought necessary. Before beginning the operation the blad der should be partially filled with acid solution, and during the time the instrument is being used a current of cold water is kept constantly passing through it in order to prevent it from becoming overheated. The recent ports upon this operation are of an en couraging character, but a still wider perience is necessary before it will be safe to express a final opinion as to its merits. That it, in common with the other operations mentioned, has a tinct mortality there is no doubt. The necessity for conducting the operation entirely in the dark and without any possibility of a safe guide is a theoretical objection that cannot be entirely over looked.
Statistical analysis of 653 cases of Bot tini's operation for prostatic hypertrophy. The mortality was 5 per cent., and the proportion of failures 6 per cent. Good results were obtained in SS per cent., about two-thirds of the latter being cured. The cause of failure is nearly al ways inadequate division of the obstruc tion. Too short an incision is, perhaps, most frequently the cause. An incision at most 4 'A to 5 centimetres in length is adequate. Freudenberg (Klin.-therap. Woch., No. IS, 1900).
Rottini's operation resorted to 30 times on 24 cases. In 9 eases there was a last ing cure, and 7 eases were much im proved. There were 2 immediate and several remote deaths sifter the operation. Cures were about 30 per cent., improved cases rather under 30 per cent., and the mortality 16 per cent. Willy Meyer (Med. Record, Ivii, 705, 793, 1900).
Among the symptoms which follow the operation is frequent urination. Ikernaturia is not infrequent, but gen erally subsides within two or three days. Fever appears more or less fre quently and epididymitis occasionally. The post-operative period is nearly three weeks and the after-treatment of these cases is as important as the oper ation itself. The patient should not be
allowed to pass from observation until the urine is clear and all symptoms of irritation have passed, and, if possible, the bladder should he explored with the eystoscope. Among the complications which follow the operation incontinence of urine must be mentioned. It occurred in 2 cases out of the writer's 36. Sixty per cent. have discontinued the use of the catheter; 20 per cent. have an in creased amount of spontaneous urina tion and are able to reduce the use of the catheter from one-half to only that which is required for occasional treat ment; 20 per cent. received no benefit, or, if any, but very little. The largest percentage of cures was among the pa tients wholly dependent upon the cath eter. Bangs (Med. Record, Mar. 9, 1901).
Results personally obtained in 161 operations for the relief of senile hyper trophy of the prostate gland suggest the following conclusions:— Success following the Bottini opera tion depends on having perfect instru ments, a good battery, the necessary skill, and the employment of a proper technique. In suitable cases the Bottini is the safest and best radical operation thus far advised for the relief of pro static hypertrophy. It is often very efficacious in advanced eases of obstruc tion as a palliative measure, rendering catheterism easy and painless, relieving spasm, lessening the tendency to con stipation, and improving the general health. It is of especial service in the beginning of obstructive symptoms due to hypertrophy of the prostate gland, and may be regarded as a means of pre venting catheter life. It is indicated in all forms of hypertrophy except where there is a valvular formation, or where there is an enormous overgrowth of the three lobes associated with tumor for mation, giving rise to a pouch, both above and below the prostate gland. Where the bladder is hopelessly dam aged, together with a general atherom atons condition of the blood-vessels, associated with polyuria, results are negative. ryelitis is not a eontra-indi cation to a resort to the operation. The character of the prostatic growth has no bearing on the results of the opera tion.
The ligation of the internal arteries for the relief of hypertrophy of the prostate gland, first recommended by Bier, has been tried by several surgeons with very unfavorable results. The benefit derived from the operation is slight, and the mortality higher than that following prostatectomy. Thus far, the results derived from angioneu rectomy have been negative. Orville Horwitz (Phila. Med. Jour., June 22, 1901).