RETENTION OF URINE CAUSED BY ENLARGED PROSTATE AND RELIEVED BY PROSTATECTOMY

GEORGE W. KING
1906 Journal of the American Medical Association (JAMA)  
Patient's History.\p=m-\Twelveyears ago the patient had an attack of retention while out prospecting and had to travel a distance of fifty miles to reach medical aid. He was easily relieved by the use of a catheter and instructed in the care and use of the instrument. By its aid he was enabled to go on with comparative comfort until a recent date. For many years he has resided alone in a cabin situated near an infrequently traveled road, and when the present attack of retention came on there
more » ... on came on there was no available way of securing assistance. He had been a sailor at one period of his career and having a flag in his possession he naturally conceived the idea of floating it at half mast as a distress signal. After some days, fortunately, it attracted the attention of a passerby who went into the cabin, and, discovering his condition, took him to the nearest physician where an attempt to pass a catheter was made without success. View of the prostate removed; weight, 5% ounces. Hospital History.-He Avas immediately sent to the hospital and came under my care. He had a history of five days' retention and there were already symptoms of uremia. Obviously the first thing to do was to relieve the retention by the usual method if possible. The prostatic obstruction was found to be so great that no form of soft catheter could be passed. A metallic instrument with long curve Avas made to enter the bladder without serious difficulty and a considerable quantity of bloody urine evacuated. The amount taken away did not axceed one-third of the contents of the bladder. This was amply sufficient to afford temporary relief, Avhich was the most urgent indication at that time. By this plan too sudden reduction Presented at a meeting of the Lewis and Clark County Medical Society. of pressure on the bladder, ureters and kidneys was avoided and time was gained for further investigation. The introduction of the instrument caused so much pain it was used but tAvice in the twenty-four hours instead of at shorter intervals. This treatment was continued during the three days preceding the operation. The obstruction being seated so high up in the pelvis, it was a debatable question Avhich route to choose. The peroneal Avas finally decided to be the safer in this instance and was therefore given the preference. Operation.-The operation was begun with the expectation that it would be difficult and so it proved to be. The groAvth could not be brought down by the sound or by any of the tractors designed for the purpose; hence the Avork had to be done almost entirely by the fingers, guided by the sense of touch, to define the boundaries of the diseased tissue. By patience and perseverance the mass, as seen in the accompanying illustration, Avas removed and free drainage established. The patient withstood the operation remarkably well for one of his years; there was no shock, and no elevation of temperature after the reactionary stage had passed. He was allowed to get up when he pleased. In fact, he did get out of bed on the day following the operation, but of course did not move about much for a day or two. His convalescence has been exceptionally rapid, a small amount of urine came through the natural passage on the sixth day, which is not the rule. With a complete healing of the wound I believe his troubles will be over. The reluctance with which the laity used to submit to the application of ice-bags or to the use of cold water in disease is fast disappearing. Wholesome and general awakening to the full appreciation of the great remedial power possessed in the scientific application of simple means like water and its different forms, vapor or ice (hydrotherapy, thermotherapy or frigerotherapy) instead of relying on antipyretic and analgesic drugs, when fighting systemic or localized inflammations, is evidence that the teaching of men like Esmarch, Winternitz, Schlikoff and others is gaining ground. There is, however, still field for educational work, not alone among the laity, but also among physicians, as there are many who still keep on "crossing the river in going after water," as the saying is. Many medical men know the value of cold applications as well as the danger of antipyretic and analgesic drugs, yet they lack the moral courage to carry theory into practice from fear of being discharged by an ignorant patient for applying anything so "dangerously" cold as an ice-bag. Furthermore, some men relegate themselves to the rear guard of the profession by condemning at all times the use of hydro-therapeutic measures and cold applications in any form, and prefer to stick to the dirty, antiquated flaxseed poultice or to some proprietary "mud" preparation with its cure-all qualities. Scientifically considered, heat and cold differ only in degrees, but let it be understood that, although the physiologic effect during their application Avithin certain limits may be identical, there is a distinct difference in the results obtained, Avhen they are applied to parts, where a pathologic process is in evidence. Thus a Avarm poultice application tends to relieve pain, but it also tends to favor the formation of bacterial growth-the formation of pus-when pyogenic germs happen to be the cause of the inflammation. On the other hand, if an ice-bag be applied to such a region it will not alone relieve congestion and pain, and that
doi:10.1001/jama.1906.62510390038003a fatcat:k5pp4hyiofhmnhdriaxvhobeny