On vesical stone and prostatic disorders : delivered before the Royal College of Surgeons of England on Dec. 9, 1896 / by Reginald Harrison.

  • Reginald Harrison
Date:
[1896?]
Catalogue details

Licence: Public Domain Mark

Credit: On vesical stone and prostatic disorders : delivered before the Royal College of Surgeons of England on Dec. 9, 1896 / by Reginald Harrison. Source: Wellcome Collection.

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    prostatic changes, in this I believe lies its comparative safety and advantage. In the next place, a portion of the vas must be resected and not merely ligatured. Pavone,'^ who has recently reported twenty-eight cases out of thirty-four where the patients were either cured or improved after vasectomy, advises that in addition to excision the ends of the canal should be twisted so as to ensure complete closure. The possibility of the restoration of the occluded vas when a liga- ture only has been used had been illustrated by Dr. Bransford Lewis.'2 Here on the return of prostatic symptoms it waa found that the continuity of the duct had been re-established after the ligature had come away. The simpUst way of per- forming the operation seems to consist in exposing the vas by a short linear incision over it and protruding it between the iinger and thumb. An aneurysm needle is then slipped under the isolated duct by means of which a loop about an inch in length is withdrawn. The latter is then in- cluded in a silk ligature when the free portion is removed by scissors. The small wound usually heals quickly. Apart, however, from some failures arising from want of attention in operating to details such as these there appear to be other reasons requiring consideration and which apply with equal force both to castration and vasectomy. I have already stated that where the prostate has passed into a fibrotic condition or where the obstructing third lobe repre- sents in structure a fibrous tumour the prospects following either opprations on the sexual apparatus are unpromising. Here McGill's operation is usually indicated. There are, however, other conditions of the prostate which must be taken into our reckoning. I am inclined to believe that if the consideration and discussion of these two operations relative to prosta'ic hypertrophy did no more than lead us to reconsider many points con- nected with the pathology of this part much will have been accomplished. I nave long i bought that slowly progressive carcinoma of the prostate, resembling in some features the more ordinary forms of hypertrophy, is far more common than is generally believed to be the case. My attention was first called to this matter in 1886, when I recorded a case which I will briefly refer to. It was that of a man aged fifty-nine years who as a private patient I had the opportunity of watching for two years up to the time of his death. In the first instance he suffered from some irritability of the bladder, which he could not completely empty. He was losing flesh, becoming pale, and though the mental faculties remained vigorous to the last he con- stantly complained of pain in the loins, nates, and thighs. In the course of a few weeks he became entirely dependent upon the catheter.- His prostate as felt from the rectum was hard, nodular, and almost insensitive to the touch, though it was not much enlarged nor were any neighbouring glands 11 11 Policlinico, No 15, 1896. 12 .Tournal of Cutaneous and Genito-Urinary Diseases. New York, 1890. 13 Op. cit., p. 509.
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