The Surgical Treatment of Prostatic Disease
In surgical diseases of the prostate gland no one surgical procedure will adequately meet all the requirements because of variations in individual cases or because of coexisting pathologic processes. Since the introduction of the first operation for the obstructing prostate, refinements in operative technics and new procedures have been frequently advocated. By the application of an adequate preoperative routine the morbidity and mortality have progressively decreased to a point where there should be no hesitancy in recommending surgical intervention for the relief of prostatism. This has been especially true since the introduction of renal function tests, studies of blood chemistry correctly interpreted, and finally transurethral resection for removal of obstructing tissue.
Several factors have to be considered in the management of patients suffering from prostatism.
Introduction of infection into the bladder may occur quite easily. This is especially true as acute or chronic distention stretches the mucosa of the bladder and favors congestion producing predisposing factors essential to the production of cystitis. If vesical neck obstruction has existed over a long period of time, ureterectasis and pyelectasis may predispose to renal infection.
If infection of the bladder is present when the patient is first seen by the physician, precautions must be taken and trauma avoided or an acute exacerbation may follow poorly executed instrumentation. Although the importance of preoperative preparation for transurethral resection has been minimized recently, with this I cannot agree. Certainly an elderly patient with a blood urea of 30–40 mg./l00 cc. is. . .