Prostatic suggestions / by Victor C. Pedersen.

  • Pedersen, Victor Cox, 1867-1958.
Date:
1911
Catalogue details

Licence: In copyright

Credit: Prostatic suggestions / by Victor C. Pedersen. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    By Victor C. Pedersen, A. M., M. D., New York. It is not many years since prostate glands were removed solely for enlargement and not with due regard for the effect exercised by the hypertrophy on the bladder, ureters, and kidneys, as being after all the chief indication for operation. Fortunately now, however, surgeons are inclined to operate for the obstruction caused by the hyper- trophy with consequent severe and progressing damage to the upper urinary tract beginning with the bladder, rather than for the hypertrophy itself. It is in order to bring out the points on which the clinical decision for operation rests in good sur- gical conservatism that the following illustrative case reports with specimens are presented. The special dictum or principle which each case aims to demonstrate will be presented as a part of each such case report. It is hoped thereby to gain more definiteness than might otherwise be possible. Case I. H. B. E., U. S., white, eighty-seven years old, widower, retired clergyman. Referred by Dr. Percival R. Bolton. The diagnosis was unusually extensive hyper- trophy of the prostate complicated by overdistention, atony, and chronic inflammation of the bladder. The family history is negative and the past personal history is that he has had the usual number of illnesses through life without damage to the kidneys. Has always enjoyed good health until retired for old age, excepting occasional illnesses of little moment. His former sexual history states that he has been mar- ried twice, and has had four children of whom one sur- vives. Venereal history is in every way negative. The present illness began about fifteen years ago when he.first noticed frequency of urination at night. This re- quired adoption of catheter life with which he had had eight or nine years’ experience when first seen. Physical examination: Reasonably healthy man of ad- vanced years. Heart and lungs normal, age considered. Abdomen bulging from flatulence. External sexual or- gans normal. Prostate gland very large, rather hard, not tender. The urinary function was greatly disturbed by an exacerbation of cystitis, so much so that he had to urinate every twenty or thirty minutes, night and day, with consequent drain upon his strength. Examination of the bladder showed it up to the navel without tone and somewhat tender to percussion. Residual urine was drawn up to twelve ounces. Urethral length, nine and one half to nine and three quarter inches. Stone searcher revealed no calculus. Was not possible to cystoscope him. Uranalysis revealed severe chronic cystitis with kidneys in reasonably good condition, there being comparatively few casts, and good percentage of urea. The treatment given this' patient was perineal drainage of the bladder, tinder cocaine, in order to relieve the cystitis. After this had been accomplished he was per- mitted to go on with his catheter life, to which was added lavage of the bladder, at first daily and finally *Case reports presented to the Medical Progress Club, April io, and to the West Side Clinical Society, April 13, 1911. Copyright, 1911, by A. R. twice a week. In this manner life has been made more than tolerable for the patient, inasmuch as his bladder has had nearly seven years of this treat- ment, and he is so well off that he is obliged to use the catheter only once at night and every five hours during the day. This patient might well have survived the opera- tion of removal of the prostate gland inasmuch as his kidneys were in reasonable condition and his general past and present health good. Since being under my care he has survived two serious illnesses which would have terminated the lives of most aged persons, which still further tends to show that his resistance to the operation would have been good. The condition of the bladder, however, was the contraindication for the removal of the gland. The muscle of the bladder had been overstretched and paralyzed by years of disease so that all recovery power was forever gone, and so that, therefore, a removal of the prostate gland would not have benefited his symptoms and might well, through paralysis of the bladder, have induced an incessant incontinence which would have been far worse than the existing conditions, relieved with the aid of the catheter. This patient, then, was one in whom an opera- tion, while scientifically inviting was, properly speaking, useless. In withholding therefore the in- clination to operate, far better service was done the man than otherwise would have been the case. That this patient will carry his cystitis to the grave is a foregone conclusion because the mucous membrane was long ago so profoundly damaged as to be beyond restitution. This is a well known fact everywhere in the body where mucous membranes abound. The limited recovery power of mucous membranes, after a certain degree of damage has occurred, is well known to specialists in diseases of the eye, ear, nose, and throat, digestive tract, and diseases of the sexual and urinary organs in both women and men. Case II. J. P. F., U. S., white, sixty-three years of age, married, occupation, merchant. The diagnosis was hypertrophy of the prostate gland with congestion and moderate cystitis. The family history is father died of nephritis, other- wise negative. His personal history is general health good, inclined to nervous indigestion with flatulence; very moderate alco- holic and slightly excessive tobacco habit. Sexual history negative. At present his sexual powers' are distinctly declining. Former venereal history negative. Present illness: Duration about three years. Chief com- plaint, frequency and. urgency of urination, especially at night with, at times, inability to empty the bladder. On such occasions there are some vesical pain and irritation. Elliott Publishing Company.