Health and Prostate

The Department of Urology of the New York Hospital
(Given January 31, 1941)

Diseases of the Prostate Gland

Prostatitis

Prostatitis is a very common disease. It is usually associated with inflammation of the posterior urethra, seminal vesicles, vesical neck, trigone, or even the epididymes, and should, therefore, be studied in relation to both the urinary and genital tracts.

1. Acute Prostatitis

Etiology and Bacteriology. The most frequent cause of acute prostatitis is gonococcal infection. Non-specific acute infections are also common and have of late received much study. The organisms most often responsible are the Staphylococcus albus and aureus, Streptococcus pyogenes, and colon bacillus, but the Bacillus proteus, diphtheroid types, or other organisms may be present. Mixed infections are frequent Contributing causes of prostatitis are masturbation over a protracted period, excessive sexual excitation without gratification, excessive sexual intercourse, and coitus interruptus.

Infection may reach the prostate by direct extension from the posterior urethra up the prostatic ducts (the most common way); or it may be descending, and secondary to an acute infection of the kidney or bladder; or blood-borne, from a primary focus in the sinuses, teeth, or tonsils; or a complication of a systemic infection, such as influenza. A chronic prostatitis may be exacerbated into an acute condition by unwise instrumentation and manipulation in the treatment of chronic posterior urethritis and prostatitis.

Pathology. Three types of acute prostatitis are recognized:

(1) acute catarrhal inflammation, which is always present in acute posterior urethritis and is usually caused by direct migration of the organisms up the prostatic tubules;

(2) follicular prostatitis, which follows the first type and is characterized by many small abscesses and distention of the tubules with pus, which is not evacuated because of obstruction of the ducts;

(3) parenchymatous prostatitis, an intensification of the second stage, the suppurative foci involving a greater extent of the surrounding stroma.

The termination of acute prostatitis is resolution, the formation of a large prostatic abscess, or chronic prostatitis.

Symptoms. The onset of acute prostatitis may be mild, with few or no local symptoms; or it may be very severe. When of urethral origin, the initial symptoms are usually disturbances of urination: urgency, frequency, burning, pain during urination, dribbling. The prostate may enlarge to the point of causing complete retention, requiring catheterization. In acute prostatitis of hematogenous origin, the attack may be ushered in by a chill or fever, and there may or may not be urinary symptoms. Pain may vary from a sense of fulness in the perineum or rectum to acute pain — in the perineum, rectum, loins, penis, or above the pubes. There is leukocytosis.

Diagnosis. Mild prostatitis is likely to escape observation during the course of acute gonorrhea. In severe cases, rectal palpation of a symmetrically enlarged, hot, tender gland is sufficient, with the symptoms and the findings of the two-glass urine test, to establish a diagnosis.

Treatment. Treatment of acute prostatitis is expectant, and consists in absolute rest in bed for all febrile cases; avoidance of physical strain and sexual excitation; avoidance of trauma to the gland; the application of heat in the form of hot sitz baths, hot rectal irrigations, or diathermy; sedatives and belladonna and opium suppositories for pain; alkalinization of the urine, and forced fluids if there is no urinary retention. With acute retention, catheterization may be necessary. Massage of the prostate and urethral instrumentation are contraindicated in the acute stage.

In addition to the above methods for symptomatic relief, chemotherapy has proved of great value in shortening the acute stage of prostatic infections. Sulfanilamide is a most useful drug in combating both gonococcal and non-specific infections. In bacillary infections, mandelic acid, and methenamine and sodium acid phosphate, are valuable.