Management of Patients with Prostatic Obstruction
In 1945 I reviewed a series of 214 patients with prostatic hypertrophy upon whom I had operated from January, 1943, to January, 1944.1 The following series of 395 patients were operated upon from January, 1944, to December, 1945. This review will compare these series, especially from the standpoint of coexisting diseases, the type of surgical procedure employed, the end results, and the mortality.
In recent years marked progress has been observed in the management of patients with bladder neck obstruction. The introduction of new antibiotic agents, adequate preoperative and postoperative management, and refinements in surgical technic have been accompanied by a progressive lowering of the operative mortality and morbidity in patients suffering from urinary obstruction.
Usually the onset of obstruction is insidious. Many men of the older age group believe nocturia, diminution in the force of the urinary stream, and dribbling to be only an indication of advancing age and fail to seek medical advice until complete obstruction occurs. Occasionally a sudden attack of urinary retention may be precipitated by exposure to cold, overindulgence in alcoholic beverages, other surgical procedures requiring confinement to bed, or other factors irritating to the bladder mucosa.
A complete physical examination is essential to ascertain the general vitality of the patient. As will be observed in the following statistics, cardiovascular and renal complications comprise the major complicating diseases in these elderly men.
A careful rectal examination is also essential to determine the extent of any proposed surgical procedure. The size of the prostate may. . .