Identifier: principlespracti1916warr (find matches)
Title: The principles and practice of surgery
Year: 1916 (1910s)
Authors: Warren, Richard, 1876-
Subjects: Surgery Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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awell-developed abscess is present the prostate will fluctuate and the wallof the rectum feel oedematous. Pus and threads, containing gonococci, are found in the deep urethra(two-glass test). Diagnosis. In tubercle of the prostate the greater chronicity, hardnodules in the prostate, absence of oedema, possibly a craggy epididymis,enlarged kidney, or tubercle bacilli in tin- urine will distinguish. 590 A TEXTBOOK K SURGERY From sarcoma of the prostate, which is rare, the absence of urethritisin the latter affection will separate, and the tact that the prostate is largerand, though elastic, is nut (edematous or tender. Treatment. The patient is kept in bed, the bowels freely opened ; hothip-baths and fomentations to the perineum are comforting, while diuresisshould be free. In most instances the abscess will burst into the urethraor be burst while passing a catheter to relieve retention of urine, which is acommon complication. Where softening of the gland is felt per rectum the
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Fig. 201. Method of opening a prostatic abscess. abscess should be opened at once to avoid any risk of a recto-urethral fistula,and this is also indicated where the abscess does not burst per urethramin a few days or where the constitutional signs are severe—rigors, &c. The simplest plan of opening these abscesses is to place the patient inthe lithotomy position and make an inch and a half incision in front of theanus, half an inch from the middle line, and then, with the left forefingeras a guide in the rectum, sinus-forceps are used to bore into the perineumand prostate till the abscess is encountered ; the opening is enlarged andthe cavity explored with the right forefinger, loculi broken down and freedrainage established, the tube being removed in four days : a urinary fistulaoften follows for a short time. Opening from the rectum is bad practiceand should be avoided. After the abscess is healed the posterior urethritiswill still need treating (see pp. 591, 612). Chronic Pro

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