Health and Prostate

The Department of Urology of the New York Hospital (Given January 31, 1941) Attention is called to the effect of disease of the prostate gland in the young as well as the old. Young men are liable to acute and chronic inflammation of the prostate, sometimes producing abscess, requiring surgery, but more often causing low back pain, urinary disturbances, and sexual disturbances. Non-surgical treatment is indicated in the latter; this consists of massage, urethral dilatation, urethrovesical irrigations, chemotherapy, hydrotherapy, diathermy, and other forms of physiotherapy. Tuberculosis of the prostate occurs fairly frequently in young men, and is usually part of a progressive urogenital tuberculosis. Treatment, as a rule, is non-surgical. Sarcoma of the prostate, a rare disease that is almost invariably fatal, affects young men and even children relatively often. Appropriate diet and medication are indicated in all prostatic conditions. Older men are subject to prostatic calculosis, and all forms of obstructive prostatism, both benign and malignant. Appropriate surgical Read more [...]

The Department of Urology of the New York Hospital (Given January 31, 1941) Benign Hypertrophy of the Prostate In all other cases, perineal prostatectomy is done. This includes enlargements which encroach on the posterior urethra. Prostatectomy for the removal of a malignant gland, or for long-standing chronic inflammation, is also accomplished through the perineum. A recent modification of the usual perineal prostatectomy, by the author, has reduced postoperative incontinence of urine to a minimum. This consists in plicating the membranous urethra just external to the apex of the prostate by the insertion of a mattress suture of ribbon gut. Recently, patients suffering from enlargement of the prostate, who have passed the period of sexual activity, have been operated upon by means of a subtotal prostatectomy, which is accomplished as follows: The prostate gland is exposed by the perineal route in the usual manner. The lateral surfaces of the gland are exposed, which is usually easily accomplished as there are seldom any adhesions from these aspects of the organ. The apex is Read more [...]

The Department of Urology of the New York Hospital (Given January 31, 1941) Benign Hypertrophy of the Prostate Treatment. Many patients with benign hypertrophy of the prostate have no obstructive symptoms and do not require surgery. In benign hypertrophy without residual urine, palliative treatment is usually advisable; this consists of periodic prostatic massage, urethral dilatations, urethrovesical irrigations, the application of heat to the prostate, and hydrotherapy. Periodic check-up is essential. Hormonal therapy affords symptomatic relief in some early cases of prostatism with slight or moderate urinary disturbances; but even its most enthusiastic advocates do not claim that it benefits all types of cases, or that it is to be considered a substitute for surgical relief in major prostatic obstruction. Roentgen therapy of benign hypertrophy also is an accepted procedure, but opinions vary as to the effect of such treatment. The more conservative urologists and radiotherapists incline to the opinion that the only effects of irradiation are a definite alleviation of the associated Read more [...]

The Department of Urology of the New York Hospital (Given January 31, 1941) Benign Hypertrophy of the Prostate Benign hypertrophy of the prostate gland occurs in from one-third to one-fifth of all men over 50 years of age. Etiology. Many theories have been advanced as to why the prostate tends to hypertrophy with age. The chief are: (i) that the hypertrophy is due to true tumor formation, which takes its origin, according to some, from the periurethral accessory glands, or, according to others, from any part of the prostate gland proper; (2) that it is a fibroepithelial growth akin to myoma of the uterus; (3) that the condition is a cystic glandular hyperplasia having its basis in infection of long standing; (4) that the hyperplasia is endocrinopathic, and due to an improper balance between the male and female hormones. Pathology. Benign hypertrophy of the prostate most frequently occurs in the middle and lateral lobes — the anterior lobe being affected rarely, and the posterior lobe practically never. My studies show that the portion which enlarges most frequently is really Read more [...]

The Department of Urology of the New York Hospital (Given January 31, 1941) Carcinoma of the Prostate Gland Carcinoma of the prostate, because of its frequency and its essentially fatal nature, presents the urologist with his most baffling problem. Young's statistics (1935) reveal that a fifth of the male patients who seek relief of obstruction of the vesical neck have carcinoma of the prostate. Pathology. A striking morphologic peculiarity of carcinoma of the prostate gland, that has been emphasized by most authors, is the diversity of its forms. In the same case, in different portions, the carcino-matous proliferation may be found at one time as an adenocarcinoma and again as a scirrhous, a medullary, or a squamous-cell carcinoma. A large percentage of prostatic carcinomas are associated with benign hypertrophy. In only 10 (13 per cent) of the 72 cases studied by Wilson and McGrath was there no evidence of associated hypertrophy. Chart I Incidence, By Age-Groups, of Carcinoma in Relation to Benign Enlargement in 280 Cases Age of group Prostates examined Per Read more [...]

The Department of Urology of the New York Hospital (Given January 31, 1941) Sarcoma of the Prostate Sarcoma of the prostate is relatively rare, and may occur at any age. A review of the literature by Lowsley and Kimball, in 1934, disclosed only 132 reported cases, 35 of which occurred in patients under 22 years of age. These tumors usually grow rapidly and attain large size, early infiltrating the bladder, seminal vesicles, and rectum. Growth of the tumor backward beneath the base of the bladder pushes the latter upward and forward, causing obstruction of the ureteral orifices, urethral orifice, and urethra, with resultant partial or complete retention. Growth of the tumor toward the perineum causes prolapse of the rectum, with obstruction to defecation and urination. Diagnosis. Early diagnosis is essential. In early cases rectal examination may be negative, but usually reveals a palpable nodule. Occasionally the growth may be indurated and nodular, but usually it is of uniform consistency and has an elastic "balloon-like" feel; hence the condition may be erroneously diagnosed Read more [...]

The Department of Urology of the New York Hospital (Given January 31, 1941) Syphilis of the Prostate Gland Syphilis of the prostate appears to be exceedingly rare. We have personally never encountered a case, and very few have been reported in the literature. Symptoms and Diagnosis. There is nothing pathognomonic either in the symptoms or the rectal findings. The chief symptom is perineal pain, usually aggravated by urination. Less common are hematuria, pain on defecation or coitus, urinary disturbances, and retention. Prostatic massage usually produces a more or less characteristic discharge. On rectal palpation the prostate will be found markedly irregular, enlarged, and sometimes nodular. The Wassermann test is usually positive. Prostatic syphilis is a late manifestation of lues, and occurs, usually, between the ages of 40 and 65 years, when it may be very difficult to differentiate it from hypertrophy of the prostate and carcinoma. Prognosis and Treatment. If diagnosed early, the disease responds readily to antiluetic treatment; if unrecognized, the prostate may be Read more [...]

The Department of Urology of the New York Hospital (Given January 31, 1941) Diseases of the Prostate Gland Prostatic Abscess Etiology. Abscess of the prostate gland may follow failure of an acute diffuse parenchymatous prostatitis to subside or to become chronic. Multiple small abscesses in the stroma coalesce to form one large abscess. A frequent cause is the gonococcus, but our own studies have shown that many other organisms may be present in abscess cavities in the prostate. Prostatic abscess may result from improper instrumentation; or occur as a complication of systemic infection; or be secondary to superficial pyogenic infections, such as carbuncles, boils, and felons. In the last event, the causative organism is the Staphylococcus aureus. Symptoms and Diagnosis. The symptoms are pain in the perineum, chills, fever, and frequent and painful urination which may progress to complete retention. Leukocytosis is present. Chronic abscess may persist for weeks without producing local symptoms. There are occasional cases of huge prostatic abscesses in which the only symptom is Read more [...]