PROSTATECTOMY FOR RETENTION OF \ / URINE.

y By C. M. THOMPSON, M.B.,

lieut.-Col., i.m.b.,

In charge, Civil Hospital, Secunderabad.

I hive not seen many cases of the above operation recorded in India; the following case may, therefore, be of some interest.

Khaja Mogul, a strong healthy-looking Mahomedan, aged about 60, was shown to me one morning at the Afzul Ganj Hospital, Hyder- abad, while I was acting as Residency Surgeon; he stated that for the last twelve months he had had increasing difficulty in passing water, and that twelve days before the date on which I saw him, he had been unable to pass any urine and had to come to hospital to have the urine drawn off two or three times a day. He was a

very powerful, strong man, a field labourer, who could not remember ever having been ill ; all his

organs were apparently perfectly healthy; urine contained no albumen, but a slight phosphatic deposit. The prostate could be easily felt to be considerably enlarged ; there was no stricture of urethra. I strongly advised him to undergo an operation, and to this he consented and was admitted to hospital. He was admitted to hospital, April 3rd;

bladder was washed out once a day with boracic acid solution and he was given small doses of

quinine and dilute nitric acid till the urine was perfectlj7 clear. On 13th April the prostate was removed in

the usual way ; an incision about 3 inches long was made over the bladder, which was distended with weak boric solution and a silver catheter

kept in ; when the bladder was exposed, two silk sutures were passed through the wall, and the bladder opened between them; the two

sutures kept the lips of the wound separated. The prostate was found to be considerably enlarged, the lateral lubes were pressed together against the catheter, and it was this lateral

pressure which caused the obstruction. There was no sign of an enlarged middle lobe, as can be seen from the illustration. The mucous membrane covering the right

lobe was scratched through with the nail of

the forefinger and the finger worked round first one lateral lobe, then the other, and last the

posterior part of the gland ; it was by no means easy to separate out the gland, regular hard work, and very tiring to the finger. Capt. Burgess, I.M.S., and Assistanl-Surgeon Abdul

Hossain, had to take turns to help me. The whole gland was eventually separated and pushed back into the bladder and was easily delivered

through the small opening in the bladder. The after-treatment of the case was as laid

down by Lt.-Col. Freyer; a large rubber tube

with two large cfrcular holes at the end was

introduced just through the opening in the

Oct., 1908.] TREATMENT OF SMALL-POX. 37S

bladder wall, and retained in position by a

couple of silk sutures; the tube was not pushed into the bladder, only just through the bladder

wall; there was never an}7 straining or discom- fort of any kind.

The catheter was removed and all urine was

passed through the wound for the first 10 days

when a silver catheter, No. 12, was easily

passed and the bladder washed out with warm

boric solution; he began to pass urine by'the

urethra on the 12th day of the operation and

on the 3rd of May the supra-pubic wound was

completely healed and all urine passed bv

urethra.

'

At the operation there was very little Weeding and after the operation he never had a sie.i or

symptom which gave me any anxiety He can

now pass urine in a large stream

i ? ir i'ii i

.

un and expresses

himself as highly pleased with the result of the

operation. I have never had an opportunity of witnessing

this operation before I operated on this case" but ] was very careful to adhere strictly to all

the directions laid down by Col, Freyer ? I was

rather surprised at the difficulty I experienced in separating out the gland.

* /

The accompanying photograph shows

prostate after removal with a catheter pas/ma

through the prostatic urethra. -

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