Causes: In dogs, house life, overfeeding, compulsory retention of
urine, and fæces, constipation, proctitis (rectitis), piles, calculi,
strangury, uric acid, urethral ulceration or stricture, rude
catheterization, chill, generative excitement to excess, secondary
abscess or infection. Forms. Lesions: follicular, interstitial,
circumscribed and diffuse suppuration. Symptoms: frequent straining
urination, rectal palpation, incontinence of urine, costiveness,
tender perineum, dullness, recumbency, fever, pus in urine, collapse
of swelling, fistula. Diagnosis. Prognosis: grave. Treatment:
laxatives, mercurials, salines, leeches, acid laxative,
non-stimulating, camphor, bromides, ergot, witch hazel, opium,
belladonna, enemata of cold water, or ice suppository,
catheterization, perineal incision, antiseptics.
_Causes._ This is most commonly seen in dogs, in which it may depend on
house life with overfeeding on stimulating, spiced, albuminous food,
compulsory restraint of urination and defecation in obedience to the
demands of cleanliness, distended bladder, and rectum, constipation,
proctitis, piles, and other sources of local irritation. In all animals
its origin is favored by the formation or arrest of calculi in the
prostate, the pelvic urethra or even the bladder; by drug strangury from
cantharides or other irritant diuretic; by excess of urea, uric acid or
other irritant in the urine; by infection extending from the urethra or
bladder; by ulceration or stricture of the urethra; by rude or
incautious catheterization, or injection; by exposure to cold; and by
local infection in pyæmia and other general zymotic disorders. Most of
these conditions conduce to local excitement and hyperæmia, which from
adjacent organs, are sympathetically transferred to the prostate. The
same is true of frequent, and intense generative excitement which
according to Lafosse and Cadiot is a common cause of prostatitis in stud
horses. Again the abscess of strangles may become localized in the
prostate, or the nodule of glanders, or the tubercle of tuberculosis
(cattle, pigs, dogs). Cadiot suggests that in animals, divested of the
tail, external injuries to the perineum may extend by continuity to the
prostate, as happens to man from horseback or bicycle riding. He adduces
no cases however. The habit of masturbation acquired by certain males
may also be adduced theoretically as both cause and consequence of
prostatitis but future observation must show how frequently this really
operates.
_Forms. Lesions._ According to the nature of the lesions the affection
has been divided into different forms 1st, =Follicular= or
=Parenchymatous=; 2d, =Diffuse= or =Interstitial=; 3d, =Circumscribed
Prostatic Abscess=; 4th, =Multiple Miliary Abscesses=.
=Follicular Prostatitis= implicates primarily the follicles and gland
ducts and finally the entire gland tissue. It is usually associated with
and doubtless often proves an extension from an adjacent infective
urethritis, and tends, in persistent cases, to go on to interstitial
inflammation and abscess, or hypertrophy. This is characterized by more
or less swelling of the prostate, with increased vascularity of its
mucosa and the oozing from its openings and gland ducts under pressure,
of a thick, yellow, gelatinoid fluid containing pus and granular
epithelial cells and sometimes striæ of blood.
=Diffuse= (=Interstitial=) =Prostatitis= shows, in addition to the
general swelling and muco-purulent discharge, a considerable exudate
into the interstitial tissue, with increased tension and resistance of
its substance. It is associated during life with more fever and
constitutional disturbance than the simple catarrhal or follicular form.
In =Circumscribed Prostatic Abscess= we find, in addition to the general
hyperæmia and swelling, a much more prominent local swelling, the seat
of intense inflammation, at first firm and resistant and later softer
and fluctuating in the centre, which is filled with pus. This may have
its origin in the follicular form, the pus becoming shut up in a
follicle and gradually increasing until it bursts into the urethra, the
bladder, the rectum, the peritoneum, or pelvic fascia and perineum. In
other cases it becomes complicated by pyæmia and secondary abscesses.
=Miliary Abscesses= may be comparatively few in number or generally
diffused through the prostate, and are often the result of a
pre-existing general infection.
_Symptoms._ As the disease usually begins as a local infection the first
symptoms are, as a rule, unattended by fever, which, however, appears in
two or three days as the local lesions increase. The urine may be passed
frequently in small amounts, or there may be frequent straining without
passage of urine, the pressure of the swollen prostate, with or without
spasm of the sphincter vescicæ, causing retention. It is no uncommon
thing to find the last urine passed of a milky or glairy character and,
coagula moulded in the prostatic canals may at times be found. The
presence of spermatic crystals, fusiform, with very pointed extremities,
and precipitated on the addition of ammonium phosphate, is
characteristic of prostatic fluid, (Fürbringer). In other cases there is
incontinence, the urine dribbling away involuntarily as the animal
walks, and especially if anything occurs to excite him. Micturition may
be painless or attended by acute suffering, which causes a sudden arrest
of the flow. Defecation is attended with difficulty and more or less
pain, and obstinate constipation is likely to set in. The animal is
dull, spiritless and seeks to lie undisturbed. Pressure on the perineum
is painful and exercise aggravates the symptoms. Rectal examination by
the hand or finger according to the size of the animal, reveals the
enlarged, tender prostate lying on the cervix vesicæ. This swelling may
be unilateral but most commonly it is bilateral or general. When fever
sets in with a temperature of 102°–104°, thirst, anorexia and weakness
or stiffness in the hind parts may be noticed. In case of abscess, the
urine may be perfectly clear until it bursts into the urethra or bladder
when there is an abundant flow of pus, and rectal examination shows that
the swelling and tension have notably diminished. Should it burst into
the rectum, the pus shows in the fæces. Reinemann records a case in a
bull with dysuria, œdema of the sheath and a swelling like the fist in
the perineum, containing pus, and which communicated with the prostate
and urethra. With the rupture of the abscess there is a marked
amelioration of the symptoms.
Not infrequently the affection subsides into the chronic form and the
abscess, having a restricted channel for evacuation, remains as a
suppurating cavity.
_Diagnosis._ The enlargement and tenderness of the prostate as felt on
rectal examination is pathognomonic. If the body of the urine is clear
there is further corroboration, as in cystitis it is more or less turbid
and flocculent or even bloodstained. Micturition is likely to be much
more frequent in cystitis than in prostatitis. Catheterization is much
more painful when the catheter passes the prostate in prostatitis than
in cystitis.
_Prognosis_ is always grave. Some cases recover completely, while others
run on to a fatal termination, and still others merge into the chronic
form. Cases that are complicated by abscess are always to be dreaded, as
chronic suppuration, or pelvic or peritoneal infection, or pyæmia, or
septic poisoning is liable to supervene. As the disease is more common
in the old so it is liable to prove more severe and redoubtable.
_Treatment._ In acute cases active derivation toward the bowels is
desirable. A mercurial purge (calomel—horse or bull 1 to 2 drs.; dog, 2
to 5 grs.) may be followed a few hours later by salines (sodium
sulphate—horse or bull 1 lb.; dog 1 oz.). Sodium sulphate or magnesium
sulphate may also be given with glycerine as an enema. Great benefit may
often be obtained from the application of leeches on the perineum or
around the anus. The diet must be restricted and non-stimulating, mainly
of amylaceous materials, and with the water, flaxseed tea may be
liberally mixed. When the suffering is severe it may be met by camphor,
camphor bromide, ergot, hamamelis, gelsemium or potassium bromide, given
by the mouth or rectum. With violent strangury, opium, belladonna or
hyoscyamus may be used. Some cases may be relieved by the use of enemata
of cold water or pieces of ice in the rectum. In retention of urine,
careful catheterization is imperative, the hand or finger in the rectum
being employed to guide the point of the catheter under the prostate.
In case of abscess an opening by the side of the anus is preferable to
one by the urinary passages or rectum, and will obviate the danger of
rupture into the peritoneum. A pasty or fluctuating swelling in the
perineum should be incised until the pus flows. A tense elastic
fluctuating prostate may be transfixed by a cannula and trochar from the
side of the anus, guided by the hand or finger in the rectum. When the
pus has been evacuated a drainage tube may be inserted through the
cannula and left in place when the latter is removed so as to allow free
drainage at all times and frequent antiseptic injections. Punctures and
even incisions have been made from the rectum, but they make badly
infected wounds, and a rupture into the urethra, determines infection on
that side, without any possibility of any effective antiseptic injection
or perfect drainage. As injections may be used permanganate of potash
1:10000, or boric acid, a saturated solution. Poisonous agents must be
eschewed or used with the greatest circumspection.