An Arris and Gale Lecture ON THE FUNCTION OF THE KIDNEYS IN ENLARGEMENT OF THE PROSTATE GLAND: Delivered before the Royal College of Surgeons of England
Authors: J. F. Dobson
Journal: BMJ (1921)

THE operation of prostatectomy for simple enlargement of tlle prostate lhas attained an establislhed position in the treatment of tlhis disease.It is attended in many cases .witlh the most satisfactory results, but a study of tlle published statistics-6f.thle oDerationof the results painted as thley are in suclh rosy colours, mightlead oiie to suppose tlidt any ian suffering from this affec- *tion could undoubtedly be cured, andi cured completely, by an ,operation entailinig little risk, a minimum of discomnfort, and no troublesome sequelae.But this is not a very accurato presentation of the facts.It is true that Sir Peter Freyer has been able to publish results showing, in the latest series of cases, a mortality of 3 per cent1.-In .avery interesting and com-.prellensivereview QR t.le ,s.ubject of -prostatectomy wllich appeared recently it is stated that experience leads to the -conclusion that to reach the success attained by Freyer thlere must be tlle most rigid selection of cases.Outside of thie select cases complications arise which induce a mortality of 15 to 25 per cent.Suraeons of experience in this operation wvill agree with these statements.It is clear that to obtain a low inortality-not altogetlher the most desirable object of the surgeon-the possible benefits of the operation must be withheld from a considerable number of sufferers.Particularly favourable results can be obtained in patients who are almost entirely above tlle lhospital class; such patienits, usually educated men, seek advice-and good advice-at an earlier stage of the dis- ease; they have more couraae to face the problem iwlichl presents itself, anid tlley are tlherefore operated upon at an earlier stage than the average lhospital patient.Tihe bladder is less frequently infected, aud they do not so commonly suffer from impaired renal functioni.PROPORTION OF OBERABLE CASES.'tENAL FUTNCTION INI-PSTATTC ENLARGEMENT.t Tsu Jarwin M NZDICAL JOUNlAA RENAL FUNCTION IN PROSTATIC ENrtARGEMENT.[TR= BuTn 2 r IM E ~~~~~~~~~~Z 1 D I C A L JOURNALcarmine and phenol-sulphone-plhthalein tests, is not suitable for those cases where a preliminary cystotomy has been done.Uniinfected Cases.iCase I.-G.H. S., aged 59.This patient was an example of the, class of case referred to where the symptoms are very slight, the patient gradually progressing towards a state of uraemia almost without knowledge of serious bladder difficulty.When first seen he was extremely ill, with a distended bladder, vomiting, a dry tongue, headache, and thirst.He was obviously on the borderline of uraemia.February 10th, 1920,-Suprapubic cystotomy under local anaes- thetic.Urine sterile.February ]2th.-Bloodurea nitrogen, 39 mg. per 100 c.cm. February 22nd.-Bloodurea nitrogen, 19.6 mg. per 100 c.cr. February 24th.-Prostatectomy.r Coincident with the fall in the blood urea his general con- dition improved markedly and prostatectomy was successfully performed on February 24th, 1920.He remains well and has no symptoms of impaired renal function.Case P.-W.A., aged 56.This patient was in a very similar condition to the first case.He had been troubled with irrita- bility for some time and the bladder had gradually become greatly distended.He was in great pain, vomiting, dry tongue, hea(lache, etc. Urine free from pus cells.February 3rd, 1920.-Bloodurea, 137 mg. per 100 c.cm. Cystotomy under local anaesthesia.February 12th.-Bloodurea, 60 mg.per 100 c.cm.February 24th.-Btoodurea, 30 mg. per 100 c.cm. March 2nd.-Bloodurea, 28 mg.per 100 c.cm. March 4th.-Prostatectomy.March 19th.-Bloodurea, 16.8 mg. per 100 c.cm.In this case there was a remarkable diminution in the blood urea after cystotomy coiucident with as remarkable a change in his general conditioii.Prostatectomy was successfully per- formed.It may be noted that the blood urea diminished after the prostate was removed.Case 3.-W.S., aged 65, was suffering from advanced organic disease of the heart, with oedema, shortniess of breath, etc.The bladder was distended, he was in great pain, vomiting, dry tongue, etc.The urine was fref from pus.Catheterization was very painful and difficult.A tied-in catheter was con- stantly coming out and suprapubic draieage was eventually established.