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BLADDER AND PROSTATE DISEASES
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See also:BLADDER AND PROSTATE DISEASES . The urinary bladder in See also:man (for the See also:anatomy see URINARY See also:SYSTEM), being the temporary See also:reservoir of the renal secretion, and, as such, containing the urine for longer or shorter periods, is liable to various important affections. These are dealt with in the first See also:part of this See also:article. The diseases of the prostate are so intimately allied that they are best considered, as in the subsequent See also:section, as part of the same subject.
Diseases of the Bladder.
Cystitis, or inflammation of the bladder, which may be acute or chronic, is due to the invasion of the mucous lining by micro-organisms, which gain See also:access either from the urethra, Cystitis. the kidneys or the See also:blood-stream. It is easy to see how
the diplococci of gonorrhoea may infect the bladder-membrane by See also:direct See also:extension of the inflammation, and how the bacilli which are swarming in the neighbouring bowel may find access to the urethra or bladder when the intervening tissues have been rendered penetrable by a See also:wound or by inflammation. Sometimes, however, especially in the See also:female, the germs from the large See also:intestine enter the bladder by way of the vulva and the urethra.
Any See also:condition leading to disturbance of the See also:function of the bladder, such as enlargement of the prostate, stricture of the urethra, See also: In the same way, See also:gout or injury may See also:lead to the lurking bacilli being enabled to effect their attack. But in every See also:case disease-germs are the cause of the trouble, and they may be found in the urine. The first effect of inflammation is to render the bladder irritable, so that as soon as a few drops of urine have collected, the individual has intense or uncontrollable See also:desire to micturate. The effort may be very painful and may be accompanied by bleeding from the overloaded blood-vessels of the inflamed membrane. ,In addition to blood, pus is likely to be found in the urine, which by this See also:time is alkaline and ammoniacal, and teeming with micro-organisms. As regards treatment, the patient should be at once sent to See also:bed in a warm See also:room, and should sit several times a See also:day in a very hot See also:hip-See also:bath. When he has got back to bed, a fomentation under oil-See also:silk, or some other See also:water-See also:proof material, should be placed over the See also:lower part of the See also:abdomen. The See also:diet should be See also:milk (diluted with hot or cold water), See also:barley-water, and See also:bread and See also:butter; no alcoholic drink should be allowed. If the urine is See also:acid, bicarbonate of soda may be given, or citrate of soda; if alkaline, urotropine—a derivative of formic aldehyde—may prove a useful urinary disinfectant. If the straining and See also:distress are See also:great, a suppository of 4 or z a See also:grain of morphia may be introduced into the rectum every two or three See also:hours. The bowels must be kept freely open. If the urine is foul, the bladder should be frequently washed out by a soft catheter and two or three feet of See also:india-See also:rubber tubing with a See also:funnel at the other end, weak and abundant hot lotions of Sanitas or Condy's fluid being used. Chronic cystitis is the condition See also:left when the acute symptoms have passed away, but it is liable at any moment to resume the acute condition. If the cystitis is very intractable, refusing to yield to hot irrigations, and to washings with nitrate of See also:silver lotion, it may be advisable to open the bladder from the front, and to explore, treat, drain and See also:rest it.
In tuberculous cystitis there is added to the symptoms the See also:discovery of the bacilli of tuberculosis in the urine, and cystoscopic examination may reveal the presence of tubercles of the mucous membrane or even of ulceration. The patient is probably losing See also:weight, and he may See also:present foci of tuberculosis at the back of the testicle, the See also:lung or See also:kidney, or in a See also:joint or See also:bone, or in a lymphatic gland. Treatment is rebellious and unpromising. Washings and lotions give but temporary See also:relief, and if the bladder is opened for rest, and for a more direct treatment, the germs of suppuration may enter, and, working in See also:conjunction with the bacilli, may cause great havoc. See also:Koch's tuberculin treatment should certainly be given a trial. This consists of the injection into the See also:body of an emulsion of dead tubeicle bacilli which have been sterilized by See also:heat. As a result of this injection the blood sets to See also:work to See also:form an " opsonin "—a protective material which so modifies the disease-germs as to render them attractive to the See also: Calculi and See also:Gravel.—Uric acid is deposited from the urine either as small crystals resembling See also:cayenne See also:pepper, or else, in combina- tion with soda and See also:ammonia, as an amorphous " See also:brick-stone. dust " See also:deposit, which, on cooling; leaves a red stain on the bottom of the See also:vessel, soluble in hot water. These substances are derived from the disintegration of nitrogenized See also:food taken in excess of demand, and from the breaking down of the human tissues. They occur therefore in fevers, in wasting diseases, and in the normal subject after excessive See also:muscular exercises, especially if these exercises have been accompanied with so much See also:perspiration that the excess of water from the blood has escaped by the skin rather than by the kidneys. The abundance of this deposit is in accordance with the amount of heat See also:developed and work done in the body, and corresponds with the dust and ashes raked out of the See also:fire-See also:box of the See also:locomotive after a See also:long run. But supposing that the uric acid debris continues to be excessive, the See also:risk of the formation of renal or vesical calculi becomes consider-able, and it may be advisable to See also:place the patient on a restricted nitrogenized diet, to induce him to drink large quantities of water, and to keep his bowels so loose with watery laxatives, such as See also:Epsom salts or sulphate of soda, that the See also:waste products of his body are made to See also:escape by the bowels rather than by the kidneys. In addition to the salts just mentioned, an occasional dose of See also:blue pill will prove helpful. A course of treatment at See also:Contrexeville or See also:Carlsbad may be taken with See also:advantage. Alkaline urine is unable to hold the See also:phosphates of ammonia and See also:magnesia in See also:solution, so they are deposited in abundance either in the kidney or bladder. If the voided urine is allowed to stand in a tall See also:glass they sink to the bottom with pus and mucus in a cloudydeposit. To remedy this condition it is necessary to treat the cystitis with which the bacterial decomposition of the urine is associated. It may be that a calculus of acid urine, such as one of uric acid or oxalate of See also:lime, has been resting in the bladder and keeping up incessant irritation, and that the micro-organisms of decomposition or suppuration have found their way to the mucous lining of the bladder from either the bowel, the urethra or the blood-stream; undergoing cultivation there they break up the See also:urea into carbonate of ammonia and so render the urine alkaline. This alkaline urine deposits its phosphates, which See also:light upon the calculus and encrust it with a mortary See also:shell, which may go on increasing in See also:size until it may even fill the bladder. Sometimes the See also:nucleus of a calculus is a chip of bone or a blood-See also:clot, or some See also:foreign substance which has been introduced into the bladder. Sooner or later the urine becomes alkaline and the calculus is encrusted with lime salts. When urine contains a larger amount of chemical constituents than it can conveniently hold in solution, a certain quantity crystallizes out, and may be deposited in the kidney or in the bladder. If the crystals run together in the kidney the resulting See also:concretion may either remain in that See also:organ or may find its way into the bladder, where it may remain to form the nucleus of a larger vesical calculus, or, especially in the case of See also:females, it may, while still small, escape from the bladder during micturition. In See also:children, in whom there is a rapid disintegration of nitrogenized tissues, a uric acid calculus in escaping from the bladder may See also:block the urethra and give rise to sudden retention of urine. On introducing a See also:metal " See also:sound," the surgeon may strike the stone, and if it happens to be near the bladder he may push it back and subsequently remove it by crushing. But if it has made its way some distance along the urethra, so that he can feel it from the outside, he should remove it by a clean incision. A stone in the bladder worries the nerves of the mucous membrane, and, giving them the impression that the bladder contains much water, causes the desire and need for micturition to be See also:constant. The irritation causes an excessive secretion of mucus, just as a piece of grit under the eyelid causes a constant See also:running from the See also:eye. So the urine, if allowed to stand, gives a copious deposit. During micturition the contracting bladder bruises its congested blood-vessels against the stone, so that towards the end of micturition blood appears in the urine. Lastly, cystitis occurs, and the urine contains fetid pus. A stone in the bladder gives rise to See also:pain at the end of the penis, and it is See also:apt suddenly to stop the flow of urine during micturition. The association of any of these symptoms leads the surgeon to suspect the presence of a stone in the bladder, and he confirms his suspicions by introducing a slender See also:steel See also:rod, a " sound," by which he strikes and feels the stone. Further See also:confirmation may be obtained by the help of the X-rays, or, in the adult, by using a cystoscope. In a See also:child the stone may often be See also:felt by a See also:finger in the rectum, the front of the bladder being pressed by a See also:hand on the lower part of the abdomen. The cystoscope is a straight, hollow metal See also:tube about the size of a long See also:cedar See also:pencil, which the surgeon introduces into the adult bladder, which has already been filled with warm boracic lotion. Down the tube run two See also:fine wires which See also:control a See also:minute electric See also:lamp at the bladder end of the instrument. At that end also is a small glass window which prevents the fluid escaping by the tube, and also a See also:prism; at the other end of the tube is an eye-piece. By the use of this slender See also:speculum the practised surgeon can recognize the presence of tubercle or tuberculous ulceration of the bladder, stone, or other foreign material, and See also:innocent or See also:malignant growths. He can also See also:watch the urine entering the bladder by the openings of the ureters, and deter-mine from which kidney blood or pus is coming. The treatment of stone in the bladder is governed by various conditions. Speaking generally, the surgeon prefers to introduce a lithotrite and crush the stone into small fragments, and then to flush out the fragments by using a full-sized, hollow metal catheter and an india-rubber See also:wash-See also:bottle. Even in children this operation may generally be adopted with success, the stone being crushed to atoms and the fragments being washed out to the last small chip. But if the stone is a very hard one (as are some of the oxalate of lime calculi), or if it is very large, or if the bladder or the prostate gland is in a See also:state of advanced disease, or if the urethra is not roomy enough to admit See also:instruments of adequate calibre, the crushing operation (lithotrity) must be deemed unsuitable, and the stone must be removed by a cutting operation (lithotomy).
Lithotomy.—Cutting for stone has been long practised; but up to the beginning of the 19th See also:century it was performed only by a few men, who, bolder than their contemporaries, had specially worked at that operation and had attained celebrity as skilful lithotomists. Patients went long distances to be operated on by them, and certain of the older surgeons, as See also: A finger introduced into the bladder makes out the exact size and position of the stone, or stones, and the removal is effected by See also:special forceps. Bleeding having ceased, the bladder-wound partly or entirely closed by sutures and allowed to fall into the pelvis, the catheter having been removed. It is advisable to leave a drainage tube in the abdominal wound for a while, so that if urine leaks from the bladder-wound it may find a ready escape to the dressings. Litholapaxy.—Lithotrity consists of two parts—the crushing of the stone, and the removal of the detritus. The two stages are now carried out at one " sitting," without an See also:interval being allowed between them, as was formerly the practice, and the See also:term " litholapaxy " designates this method. The patient having been anaesthetized, to oz. of hot boracic lotion are injected, and the crushing instrument, the lithotrite, is then passed into the bladder. The lithotrite has two See also:blades, a " male " and a " female," the latter fenestrated, the former solid with its See also:surface notched. When the stone is fixed between the blades the See also:screw is used, and great pressure is applied evenly, gradually and continuously to the stone. The lithotrite is made of very tough steel, so that hard stones may be crushed without danger of the instrument breaking or bending. Care must be taken not to catch the bladder-wall with the lithotrite. This danger is avoided by raising the point of the lithotrite immediately after grasping the stone and before crushing. The stone breaks into two or more pieces, and these fragments must be crushed, one by one, until they are powdered fine enough to escape by the large evacuating catheter. If the stone be large and hard, See also:half an See also:hour or longer may be required to crush it sufficiently fine. When the surgeon fails to catch any more large pieces, the presumption is that the stone has been thoroughly broken up. The lithotrite is then withdrawn and the detritus is washed out by an " aspirator," which consists of a stiff elastic See also:ball which is connected with a See also:trap, into which fragments of stone fall so as not to pass out on the instrument being used at later periods in the operation. A large catheter, with the eye very near the end ofthe See also:short See also:curve, is passed into the bladder; the aspirator, full of boracic lotion, is attached to the catheter, and a few ounces of the fluid are expressed from the aspirator into the bladder by squeezing the rubber ball. When the pressure is taken off the ball, it dilates and draws the fluid out of the bladder, and with it some of the detritus, which falls into the trap. This is repeated until all the fragments have been removed. After the operation the patient sometimes suffers from discomfort. His urine should be See also:drawn off by a soft catheter at See also:regular intervals for a few days. If the pain be severe, it can generally be relieved by fomentations. The patient must be kept in bed after the operation, and in cases where the stone has been large and the bladder irritable, the surgeon should insist on his remaining there for at least a See also:week; in those cases which go on favourably the patients are soon able to perform their See also:ordinary duties. Fatal terminations, however, do now and again occur from suppression of urine, the result of the old-See also:standing kidney disease which so often complicates these cases. To See also:Brigade-Surgeon See also:Lieutenant-See also:Colonel See also:Dennis See also:Francis Keegan, of the See also:Indian Medical Service, is due the fact that the operation of crushing and promptly removing all fragments of a vesical calculus is as well suited for boys as for men. In entire opposition to long-standing See also:European prejudices, Keegan's operation is now firmly and permanently established. The old operation (Cheselden's) of cutting a stone out through the bottom of a boy's bladder is now seldom resorted to, and if a stone in a boy is found too large or too hard to lend itself to the crushing operation, it is removed by a See also:vertical incision through the lower part of the anterior wall of the abdomen, as described above. For a successful performance of the crushing operation in a boy a small lithotrite has, of course, to be used, and it must be of the very best See also:English make. The operation has to be done with the utmost gentleness and thoroughness, not a particle of the crushed stone being left in the bladder, since otherwise the piece left becomes the nucleus of a fresh stone and the trouble recurs. The treatment of vesical calculi by other means than operative See also:surgery is of little value. Attempts have been made to dissolve them by See also:internal remedies, or by the injection of chemical agents into the bladder; but, although such methods have for a time been apparently successful, they have invariably been found worthless for removing calculi once actually formed. Nevertheless, much can be done towards Preventing the formation of calculi in those who have a tendency to their formation, by See also:attention to diet, by taking proper exercise, and by the internal See also:administration of drugs. Rupture of the bladder may be caused by a kick or See also:blow over the upper part of the abdomen, or by a See also:wheel passing over it; or it may be a complication of fracture of the pelvis. If the rupture is in that part of the bladder which is uncovered by the peritoneum, the extravasated urine may be cut down upon and let out with good prospect of success; but if the rupture is in the upper or hinder part of the bladder the urine is let loose into the See also:general peritoneal cavity and sets up See also:peritonitis, which is more than likely to prove fatal. If the surgeon knows that the bladder is ruptured he should operate at once in See also:order to provide escape for the urine, and also to sew up the See also:rent. If the possibility of the bladder being ruptured be even suspected, the surgeon should pass a catheter. Perhaps he draws off an See also:ounce or two of blood-stained urine. This makes him doubly suspicious, so he injects into the bladder five, eight or ten ounces of warm boracic lotion, and, leaving it there for a few minutes, he See also:measures the amount which he is able afterwards to withdraw; if he finds that a certain amount is lost he is assured that a leakage has taken place and he at once proceeds to operate. If only the diagnosis is made promptly, and the operation is at once undertaken, the outlook is not unfavourable. A See also:generation or so back nearly all the cases of rupture of bladder ended fatally. Villous disease of the bladder is innocent; that is to say, it does not spread to the neighbouring structures or implicate the lymphatic glands. The villi are slender, branched, filamentous processes which, springing from the See also:floor of the bladder, See also:float in the urine like seaweed. They are freely supplied with blood-vessels, so that when a piece. of a villus is broken off there is likely to be blood in the urine. Indeed, painless See also:haemorrhage is one of the characteristic features of the disease, and when fragments of the " seaweed " are found in the urine the diagnosis is clear. If the bladder is opened from the front, as already described, the villi may be nipped off by special forceps and the disease permanently cured. Malignant disease of the bladder is almost always the warty form of See also:cancer known as epithelioma. It springs as a sessile growth from the mucous membrane of the floor near the opening of one of the ureters, and, worrying the sensory nerves, causes irritability of the bladder and incontinence of urine. In due course septic germs reach the bladder, either from the urethra, the bowel, the kidneys or the blood-stream, and cystitis sets in. When ulceration has taken place, blood occurs in the urine, and the patient—generally beyond middle age—suffers dull or lancinating pains. Eventually the rectum may also be involved and the distress becomes extreme. The presence of the growth may be determined by See also:sounding the bladder, by the cystoscope, and by the finger in the rectum. If the growth invades the outlet, retention of urine may occur, and the surgeon may be compelled to open the bladder from the front of the abdomen. In cases where operation is out of the question, washing the bladder with hot boracic lotion may give great relief. The treatment of cancer of the bladder by operation is, as a See also:rule, unsatisfactory, because of the See also:close proximity of the growth to the ureters and to the rectum. If, however, the disease were recognized See also:early and had not invaded the neighbouring structures, and if it were upon the upper or the anterior part of the bladder, its removal might be hopefully undertaken. See also:Hypertrophy and See also:Dilatation.—When there is long-continued obstruction to the flow of urine, as in stricture of the urethra, or enlargement of the prostate, the bladder-wall becomes much thickened, the muscular fibres increasing both in size and number; the condition is known as " hypertrophy." Hypertrophy may be accompanied by dilatation of the bladder, a condition which the bladder may assume when the voiding of its contents is interfered with for a length of time. See also:Paralysis of the bladder is a want of contractile See also:power in the muscular fibres of the bladder-wall. It may result from injuries whereby the See also:spinal See also:cord is lacerated or pressed upon, so that the micturition centre, which is situated in the lumbar region, is thrown out of working order. The result may be either retention or in-continence of urine; sometimes there is at first retention, which later is followed by incontinence. Paralysis is also met with in certain See also:nervous diseases, as in locomotor ataxia, and in various cerebral lesions, as in See also:apoplexy. Atony of the bladder is a paresis or partial paralysis. It is due to a want of See also:tone in the muscular fibres, and is frequently the result of over-distension of the bladder, such as may occur in cases of enlargement of the prostate. The patient is unable to empty the bladder, and the condition of atony gets increasingly worse. In both paralysis and atony the indication is carefully to prevent over-distension by the urine being retained too long, and at the same time to treat by appropriate means the cause which has produced or is keeping up the condition. Incontinence of urine may occur in the adult or in the child, but is due to widely different causes in the two cases. In the child it may be simply a See also:bad See also:habit, the child not having been properly trained; but more frequently there is a want of control in the micturition-centre, so that the child passes its water unwittingly, especially during the See also:night. In adults it is not so much a condition of incontinence in the sense of water being passed against' the will, but is a See also:suggestion that the bladder is already full, the water which passes being the overflow from a too full reservoir. It is usually caused by an obstruction external to the bladder, e.g. enlarged See also:pro-state or stricture of the urethra; a calculus may produce the condition. In the child an See also:attempt must be made to improve the tone of the micturition-centre by the use of See also:belladonna or See also:strychnine internally, and of a See also:blister or faradism externally over the lumbar region, and every effort should be made to See also:train the child to pass water at stated times and regular intervals. In the adult the cause which produces the over-distension must be removed if possible; but, as a rule, the patient has to be provided with a catheter, which he can pass before the bladder has filled to overflowing. A sof t flexible catheter should be given in preference to a rigid or semi-rigid one. The best form is the red-rubber catheter, and he should be taught the need of keeping it absolutely clean. In the case of children incontinence of urine means irritability; in adults it means overflow. The condition termed by Sir See also: But when there is an obstruction which cannot be overcome, aspiration has to be resorted to, the See also:needle of the aspirator being pushed through the abdominal wall into the bladder. The point of puncture in the abdominal wall is in the middle line a few inches above the symphysis pubis. The bladder may be emptied in this way very many times in the same See also:person with only good result. Diseases of Prostate Gland. The prostate gland may become acutely inflamed as the result of the backward extension of gonorrhoeal inflammation of the urethra; it may also be attacked by the germs of ordinary suppuration as well as by the bacilli of tuberculosis. A sudden enlargement of a large gland lying against the outlets of the bladder and the bowel renders micturition difficult, painful or impossible, and interferes with defaecation. Pressure of the seat of the See also:chair upon the perineum also causes distress, so the man sits sideways and on the edge of the seat. If See also:abscess forms, it should be incised from the perineum; if allowed to run its course it may burst into the bladder, the urethra or the rectum, and set up serious complication. The treatment of prostatitis (inflammation of the prostate) consists in rest in bed, sitz-See also:baths and fomentations. If retention of urine takes place a soft catheter must be passed. In the early See also:stage of an acute attack a dozen leeches upon the perineum may do good. The bowels must be kept freely open, and from time to time, as the pain demands, a morphia suppository may be introduced into the bowel. Chronic prostatitis is a See also:legacy from a See also:recent or long-past attack of gonorrhoea. The enlargement gives rise to afeeling of weight and fulness in the perineum, irritability of the bladder, and a gleety urethral See also:discharge. See also:Manual examination reveals the presence of a large, hard See also:mass in front of the bladder, and in the mass there can often be felt softish or See also:tender areas which seem to threaten abscess. On urine being passed into a glass, a cloudiness is seen, and material like pieces of See also:vermicelli or broken threads may be noticed. These are the castings from the long tubular glands, and are characteristic of chronic inflammation of the prostate. The occasional passage of a large metal bougie, the use of weak lotions of nitrate of silver, the administration of See also:quinine and See also:iron, and the application of blisters to the perineum, may be tried as circumstances direct. The patient should lead a quiet See also:life, See also:free from sexual excitement. See also:Horse-exercise, See also:cycle-See also:riding, rough See also:games and See also:alcohol should be avoided. Enlargement of the prostate exists in a considerable proportion of men of about sixty years of See also:age and onward. It consists of an uncontrolled growth of the normal muscular and glandular See also:tissue of the prostate, interfering with, or absolutely stopping, the outflow of the urine. Gently pushing the bladder upwards and backwards, it increases the length of the urethra, so that in order to draw off retained urine the catheter must be longer than ordinary, but inasmuch as there is no actual narrowing of the passage it may be of full calibre. The See also:beak should be well turned up so that it may ride in front of, and surmount, the median enlargement. Because of the thick, See also:ring-like mass of new tissue around the outlet of the bladder, there is difficulty in micturition, and because the muscular bladder wall is now unable to See also:contract upon all its contents a certain amount of urine is retained. As the enlarged prostate bulges up in the floor of the bladder, a pouch or hollow forms behind it, from which the muscular wall is unable to dislodge the stagnant urine. This keeps up constant irritation, and if by See also:chance the germs of decomposition find their way thither, cystitis sets in and the patient's condition becomes serious, not only because of the risk to which his tired and irritated kidneys are submitted, but because of the possibility of a phosphatic stone being formed in the bladder. The seriousness of enlargement of the prostate does not depend upon the size of the growth so much as upon the inability of the patient to empty his bladder completely. The surgeon forms his estimate of the size of the prostate by rectal examination. But sometimes a patient has retention of urine from enlarged prostate, when by this method of manual examination the amount of increase appears quite unimportant. The explanation is that the enlargement is chiefly confined to a small piece of the gland which protrudes like a See also:tongue into the water-way. See also:Robert M°Gill of See also:Leeds was the first surgeon to remove by a supra-pubic operation this tongue-like See also:process of new prostatic growth. Attempts had sometimes been made to get rid of it by See also:instrumentation through the urethra, but they had not met with much success. When the surgeon has made out the existence of an enlargement of the prostate, the next thing is to find to what extent this interferes with the bladder being emptied. To do this, he asks the patient to pass,as much water as he is able, and then with due precautions introduces a soft catheter and measures the amount of urine which he thus draws off—half an ounce, an ounce, two ounces, however much it may be. It is this " residual urine " which causes the annoyance and the danger of enlarged prostate, and unless arrangements can be made for its regular withdrawal serious trouble is almost certain to ensue. The passing of a large catheter may have the effect of so opening up the water-way that, at any See also:rate for a time, the irritability of the bladder may cease, in which case the patient may be instructed in the See also:art of passing a catheter for himself. Or the surgeon may find that in addition to the regular passing of a large catheteran occasional washing-out of the bladder with hot boracic lotion is all that is needed in the way of active treatment. At the same time, however; the patient is placed upon a See also:plain and wholesome diet with little or no alcohol, and he is instructed to lead in every respect a regular and quiet life. To many men with enlarged prostate the passing of an instrument night and See also:morning is no great hardship, while to others the See also:idea of leading what is called a " catheter life " appears intolerable, or, having for a time been patiently carried out, is found not only severely trying but greatly disappointing. In some See also:people the very first passing of a catheter sets up a See also:local and constitutional disturbance, the bladder being rendered irritable and intolerant, the temperature going up, and shiverings and perspirations manifesting themselves. This condition was formerly called " catheter fever," and was looked upon as something mysterious and See also:peculiar. It is now generally understood to be the result of septic inoculation of the interior of the bladder. Lastly, in other persons the passing of the catheter is attended with so much difficulty, distress or bleeding, that something more helpful and effectual is urgently called for. Operative Treatment.—It has long been known that large tumours of the uterus sometimes dwindle if the ovaries are removed by operation, and See also:Professor William White of See also:Philadelphia thought that prostatic growths might be similarly influenced by the removal of the testicles. Beyond question considerable improvement has followed this operation in cases of enlargement of the prostate, especially where the enlargement seemed to be general, soft and vascular. A similar though perhaps a slower effect is produced when the duct of the testis, the vas deferens, is divided on each side of the body. If there is no great urgency about the case this treatment may well be tried, the bladder being all the while duly emptied by catheter and washed by See also:irrigation. But if the case is urgent, there being difficulty or bleeding with the passing of the catheter, the bladder being excessively irritable and the urine foul, a more See also:radical measure is needed. The best operation is that upon the lines laid down by Robert McGill, who opened the bladder through the anterior abdominal wall and removed that part of the prostate gland which was blocking the water-way. M°Gill's operation was improved upon by See also:Eugene See also:Fuller of New See also:York, who, in 1895, published a full See also:account of his See also:procedure.' Having opened the bladder from the front (as in supra-pubic lithotomy), he introduced his left index finger into the rectum and thrust the prostate gland towards the right index finger, which was then in the bladder. With the See also:nail of that finger, or with the end of a pair of See also:scissors, he made a rent in the mucous membrane of the bladder and the See also:capsule of the gland, and then shelled out the mass of new tissue which had caused the prostatic enlargement. This operation is called " prostatectomy," which means the removal of the prostate gland. The prostate gland, however, is not removed, but only a muscular and glandular mass (adenoma), which, growing within the prostatic capsule, encircles the urethra and squeezes the See also:original gland tissue out of existence. Following on the lines of McGill and Fuller, P. J. Freyer has done excellent work in See also:England towards placing this operation upon a sound basis. Subsequently to the operation the bladder enjoys complete ' Diseases of the Genita-urinary System, by Eugene Fuller, M.D. (See also:London and New York, 1900).and needful rest, and the kidneys, which previously were in a condition of perpetual disturbance, improve in working power. The wound in the bladder and in the abdominal wall gradually closes; the function of the bladder returns, and the patient is soon able to go back to his usual occupation in greatly improved See also:health and vigour. The operation is, necessarily, a serious one, and the age of the patient, the condition of his bladder, of his kidneys, and of his blood-vessels, require to be taken into See also:consideration; still, the operation gives an excellent account of itself in See also:statistics, and if a See also:practical surgeon advises a patient to accept its risks his counsel may well be followed. Malignant disease of the prostate is distinguished from senile glandular enlargement by the rapidity of its growth, by the freeness of the bleeding which is associated with the introduction of a catheter, and by the marked wasting which the individual undergoes. Unfortunately, by the time that the cancerous nature of the disease is definitely recognized, the prospect of relief being afforded by operation is small. (E. 0.*) BLADDER-WORT, the name given to a submerged water plant, Utricularia vulgaris, with finely divided leaves upon which are See also:borne small bladders provided with trap-See also:door entrances which open only inwards. Small crustaceans and other aquatic animals push their way into the bladders and are unable to escape. The products of the decay of the organisms thus A, Bladder of . Utricularia neglecta (after See also:Darwin), enlarged. B, stellate hairs from interior of bladder of U. vulgaris. captured are absorbed into the plant by See also:star-shaped hairs which line. the interior of the bladder. In this way the plant is supplied with nitrogenous food from the See also:animal See also:kingdom. Bladder-wort bears small, yellow, two-lipped See also:flowers on a See also:stem which rises above the surface of the water. It is found in pools and ditches in the See also:British Isles, and is widely distributed in the See also:north temperate See also:zone. The genus contains about two See also:hundred See also:species in tropical and temperate regions. Additional information and CommentsThere are no comments yet for this article.
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