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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    to operate forthwith, as his bladder would no longer resist the disadvantages under which it was work- ing. Case III. W. B., fifty-two years old, married, insur- ance broker. Referred through the courtesy of Dr. Jona- than G. Wells. Diagnosis: Hypertrophy of the prostate gland, especially of the middle lobe (ball valve action). Family history and former personal history, negative, Denies insistently any venereal disease or disorder ex- cepting masturbation for a short time as a boy. Present illness began four years ago when he noticed his urination was more frequent, less under voluntary con- trol and somewhat disturbing at night. At that time he went to one of our leading urologists, who did not do a cystoscopy and treated him with irrigations of the blad- der and massage, all without benefit of lasting character. At the time of his first visit he reported his urination to be once every few hours by day and at least one or more times by night, occasionally many times. The stream had become double and forked, urgency great, control incom- plete, and, at times, absent. There never had been ob- struction. Considerable pain was present in the penis, bladder, rectum, and perinaeum especially during and after urination and at times after defaecation. The man suffered from no disturbance of the sexual function. He had, however, become extremely nervous with periods of irritability, depriving him of his sleep. Physical examination: Normal except for nervousness. Heart, lungs, abdomen, and external genitals normal. Fig. 4.—Nearly natural size. Shows the gland from below as a solid mass of hypertrophy with no distinction between right, left, and middle lobe. Prostatic examination was painful and revealed a hard moderate general hypertrophy particularly that of the middle lobe. A stone searcher caught upon the middle lobe. Urination was with straining, slightly turbid, urine being passed about two ounces in amount. Effort to pass more urine failed. Residual urine drawn with a 16 F. coude catheter was three and a half ounces. Urethral examination showed length of nine inches and a calibre without pain of 16 F. Endoscopy revealed great- ly congested prostatic urethra and a middle lobe over which it was not possible to see. Cystoscopy showed a large middle lobe with the ureters just visible beyond it. Numerous shallow trabeculations covered with apparently normal uninflamed mucous membrane were easily made out. Four small oxalate concretions were found on the floor of the bladder about the size of pin heads. Uranalysis showed a decided trace of albumin, less than one tenth of one per cent., no sugar; normal urea; undis- torted pus cells, many crystals of uric acid and calcium oxalate. Scattered hyaline casts. Operation was suggested by me and accepted bv the patient on the grounds that treatment by an expert with irrigations, massage, and medication, persisted in for a long time, had failed to give benefit and that his condition was steadily growing worse. There was, therefore, noth- ing to be gained and a great deal to be lost by allowing matters to remain unrelieved. Accordingly a suprapubic operation was undertaken with the kindly services of Dr. K. B. Page as consultant, W. B. Brouner as assistant, and Dr. Denton, as anaesthetist. The bladder was readily opened and a middle lobe more or less pedunculated so as to act as a ball valve, was re- Fig. 5.—Also practically natural size.. Shows somewhat greater enlargement in the lateral lobes than in the middle. lobes. The hardening of the specimen in the formalin made it impossible to pass a probe through the urethra without damaging the specimen. In this patient, however, the calibre of the urethra was very greatly obstructed in life. moved. The bladder was explored for stone negatively, a large drain was inserted, and the patient returned to bed. As there had been little or no cystitis the tube was removed on the second day; irrigations of the bladder through the wound were begun on the third day. All the immediate results were excellent. The final results will be most prosperous, because the cut off. muscle of the bladder and the deep urethra were not invaded at all. The prostate gland as a whole was found to be prac- tically normal. It was, therefore, not enucleated, on the ground that it was better to remove the obvious cause ot the trouble and allow Nature to restore the balance of the prostate gland left in place. Figure 1 illustrates the specimen from this case. This case therefore represents a transitional step between Case II with a large prostate causing little or no trouble except when congested and without having had a cystitis and Case IV where a cured se- vere cystitis relapsed and remained incurable because Fig. 6.—Somewhat distinctly smaller than in nature; from below. The enlarged right lobe presents with comparatively little enlarge- ment of the middle lobe so that the left lobe is visible beyond. The formalin specimen required coaxing of an 18 F. catheter through the urethra, which tore a little fresh tissue shown in white on the left of the photograph, the specimen as a whole having been discolored somewhat.