Studies on hypertrophy and cancer of the prostate.

  • Young, Hugh H., 1870-1945.
Date:
1906
Catalogue details

Licence: Public Domain Mark

Credit: Studies on hypertrophy and cancer of the prostate. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    My next four cases were characterized by considerable middle lobe enlargements, and I therefore used the suprapubic route, and was sur- prised to find that with the assistance of the finger in the rectum I could easily enucleate very large lateral lobes in one piece with the median without destroying the urethra. The operation was also very much quicker—it frequently being possible to complete the enucleation in five to six minutes, whereas the combined operation would fre- quently take nearly an hour. The principal objection to the perineal route was the necessity of the suprapubic incision to push the prostate down into the perineum where it could be enucleated, and I then thought of having an instru- ment made with two blades which could be inserted closed through a perineal urethrotomy, separated when in the bladder, and then used as a tractor to drag the prostate toward the perineum. This was in 1899, but I never had the instrument constructed, but continued to do all prostatectomies suprapubically. The results obtained were excellent, the greatest objection being the considerable hemorrhage following the operation, the great duration of the convalescence and the occa- sional development of suprapubic hernia afterward. In 1899 several patients came to me who were so old and so weak that I was afraid to even administer a general anesthetic, much less to do so severe an operation as a suprapubic prostatectomy. One patient being unable to use a catheter, caused me to purchase a Bot- tini incisor, and the results which I obtained on extremely old and feeble men, under local cocaine ansesthesia, were indeed so marvellous that I adopted the Bottini operation as the method of choice in cases past 65 years of age, who were not in a prime surgical condition. Using my instrument with interchangeable blades of different size I was able to operate safely and radically on prostates of any size. I found it possible also to successfully attack large middle lobes by making an oblique incision with the cautery blade on each side of the pedicle, thus dropping it back out of the way, where it would after- ward atrophy. In two years I operated thus on 40 cases, with two deaths, only one of which was due to the operation. Of these 15 were over 70 and three over 80, with no deaths, and with cures in all these cases but one. I feel sure that many of these patients would have succumbed had a suprapubic or a combined prostatectomy under general anaesthesia been done, with the subsequent prolonged recumbent posture. The