File:The practice of surgery (1910) (14778908262).jpg

Identifier: practiceofsurger00mumf (find matches)
Title: The practice of surgery
Year: 1910 (1910s)
Authors: Mumford, James Gregory, 1863-1914
Subjects: Surgery
Publisher: Philadelphia and London, W. B. Saunders company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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se variations in size and shape may puzzle the stu-dent, but he should study the formations on the cadaver and in plates. The syynptoms of enlarged prostate should be obvious to the readerwho is familiar with diseases of the bladder, for the prostate, when en- HYPERTROPHY OF THE PROSTATE 417 largcd, becomes essentially a tumor of the bladder-wall, while necessarilyit involves the urethra at the same time. Therefore, the first and mostcharacteristic symptom of enlarged prostate is Jrequcncy of micturition;and note this characteristic fact, that the frequency is most pronouncedat night, and is due to a congestion of the bladder and prostate. Nextthe patient notices difficulty in passing water, so that the act is accomp-lished with straining and more or less pain. The difficulty increaseswith time, until the flow comes drop by drop. This difficulty is due tothe tortuous course into which the urethra has been forced by theenlarging prostate, and to the consequent elevation of the internal
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Fig. 250.—General prostatic enlargement with the formation of a median over-growth and posterior pocket or sac. Illustrating how residual urine may beretained, as well as the difficulties of all kinds of instrumentation (Socin and Burck-hardt). meatus toward the front of the bladder-wall, where a valve-like openingis formed, which excessive straining closes. As the enlarged prostateencroaches upon the urethra within it, it throws the lower posterior partof the bladder into a cup-like fold, depressed beneath and behind theinternal meatus. As a result, urine which cannot be evacuated collectsin this pocket—so-called residual urine, that which remains afterthe patient has evacuated all that he can (Fig. 250). With such con-ditions present one maj^ easily picture the complications and resultsof prostatic enlargement. An underlying gonorrhea, exposure to coldand wet, some slight injury, or some intercurrent illness may be the 27 418 GEXITO-UKIXARY ORGANS immediate cause of an acute inf

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