Transvesical prostatectomy in two stages : with remarks upon the pathology and clinical phases of prostatic obstruction / by Paul Monroe Pilcher.

  • Pilcher, Paul M. (Paul Monroe), 1876-1917.
Date:
[1914], ©1914
Catalogue details

Licence: Public Domain Mark

Credit: Transvesical prostatectomy in two stages : with remarks upon the pathology and clinical phases of prostatic obstruction / by Paul Monroe Pilcher. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    38/82 (page 30)
    and there is a chronic retention of a considerable amount of urine with very Httle overflow, the amount of urine secreted will often average as high as 120 to 150 ounces in twenty-four hours with a low specific gravity. Where we have a contracted bladder with greatly thickened walls, in which there is only a small amount of retention, and the amount of retained urine almost entirely fills the contracted bladder, the urine is passed very frequently and in small amounts. Such a bladder may contain only two or three ounces and is almost continuously full. Under such conditions the kidney seems to diminish its secretions. The total amount secreted in twenty-four hours may be very little, finally result- ing in complete anuria. The other cases are those of acute retention of urine, in which the kidneys act freely until the bladder is filled to its capacity, at which time the kidneys stop acting entirely. It must be remembered that the bladder will never rupture from overdistention due to accumulation of urine. Aside from the clinical evidence of renal infection and renal insufficiency already presented, the most striking evidence of renal injury due to prostatic obstruction is presented in those cases dying from the disease. Autopsy shows a variety of conditions existing in the kidney, the lesion most common to all being a hydro-ureter beginning immediately above the bladder, resulting in various degrees of hydronephrosis and de- struction of the kidney parenchyma. This in turn is influenced by the degree and duration of the obstruction and in more advanced cases is accompanied by infection, the formation of renal calculi, and, in some cases, by actual infection and destruc- tion of the kidney parenchyma.^ To the mind of the writer those lesions are brought about by two mechanical conditions: i. The hypertrophy of the mus- cular walls of the bladder through which the lower end of the ureter passes and, 2, the constant presence of residual urine which helps to keep the muscles compressed and forming a Wade: Prostatism, Fig. 40. March Annals of Surgery, p. 334.