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complete) he remarks as noteworthy, that 5 had small prostates and incomplete retention. The total number of small prostates Trental Tablets he subjected to prostatec- tomy was eleven. Five of these had an enlarged median lobe ; its removal was followed by a perfect result. Six had no enlarged median lobe and netted only one perfect result. He calls the pathological state presented by these six cases, chronic hyper- trophic prostatitis. He says that it sometimes even- tuates in complete retention ; but that the partial re- tention is not due so Buy Cheap Trental much to visible obstruction as to imperfect opening of the urethrovesical orifice. It is pertinent to remark Order Trental here that these are the Nov. 24, 1906] MEDICAL RECORD. 817 cases in which prostatotomy by either the llottini instrument or a bistoury is of service when any surgical intervention is indicated, and that, as Albar- ran says, they are rarely benefited, in fact are often made worse by prostatectomy. Case I., incipient prostatic enlargement, illus- trates the value of palliative treatment in postponing indefinitely the necessity for radical measures. V. R., 51, married, always a hard manual worker and looking older than his given age, had suffered frequency of urination, slight hesitancy and initial pain for two years. These symptoms had developed gradually ; it was two months before they had Buy Trental reached their climax. The frequency rose to an hour and a half, and the complete emptying Trental Generic of the bladder meant a teasing desire gradually relieved by the discharge of a small quantity of urine every fif- teen minutes. That the quality of his urine had had something to do with his symptoms is evidenced by two facts : the occurrence of a general pruritus ap- parently of lithemic origin concomitant with his greatest frequency, and the slight, temporary im- provement that had followed medication by his phy- sician. Recently the frequency had been two hours. He had had no venereal disease. His sexual life, which began with his marriage at 26 years of age, had been normal, barring a moderate frequency in coitus during the first five years. Desire began to wane with the onset of the bladder symptoms and he had not cohabited in the past six months. Ex- amination showed three ounces of residual urine and an enlargement of the prostate, the Trental Mg left lobe espe- cially, as felt by rectum. Under treatment that comprised irrigations with and instillations of silver nitrate solutions, and digital massage of the prostate, Generic Trental his frequency at once began to decrease and his residual urine to diminish. This improvement has been constant and progressive. Since the eighth week he has been able to hold his urine three hours comfortably and up to four hours when necessary ; he has not had to uri- nate more than once a night — many nights not at all — and the residual, accurately measured, is two drachms. His urine has been and is of normal ap- pearance ; the urethral length is 8^2 inches ; the pros- tate is now about normal Trental Cost in size, but dense and hard, the left lobe especially. He declares he is comfort- able and that his urination is steadily improving. It is probable that if he could modify his diet and im- prove his assimilation, a further reduction Trental Price in his diurnal frequency would result. Case H. illustrates a class, many of which, Purchase Trental Online un- doubtedly, have been hurried into an unwarranted operation. It raises the question whether it is good practice always to perform prostatectomy on the oc- currence of the first retention. The case is typical and not rare. V. Q. J., 63, single, had been in the habit of hold- ing his urine for an hour or more overtime during the preceding two years. Apparently, however, he experienced no urinary symptoms until a recent va- cation that exposed him to unexpected discomforts and coarse, poorly-cooked fare. Within a few days there developed frequency, some ardor, considerable tenesmus, and incontinence whenever recumbent, awake or asleep. The frequency was fifteen minutes day and night. The incontinence amounted to a few drops when he was awake : but to a large volume when asleep. Under medical treatment by his phy- sician the symptoms persisted for Buy Trental Online a week, then be- gan to abate gradually. When he was referred to me, seventeen days after the onset, the diurnal fre- quency was only an hour and a half, only slight ardor remained, and the tenesmus practically had ceased ; but the nocturnal frequency had been en- tirely superseded by the incontinence, made worse by the large quantities of water he was drinking by advice. He has always been a total abstainer from alcohol ; he has not used tobacco in twelve years ; he drinks coffee twice daily. There is a history of a venereal lesion fifteen years ago without sequela. His sexual life has been extremely negative. Examination showed an overdistended bladder reaching to the umbilicus and obscuring the contour of the prostate by bulging downward toward the rectum. Out of respect for the patient's exhausted condition and timidity, instrumentation was not un- dertaken on this occasion, his first visit ; but the daily allowance of water was reduced to physiolog- ical limits, his coffee was restricted, and his fluid diet was replaced by solids. He refused to remain in bed until it should become imperative, though the possibilities were told him. Within forty-eight hours the ardor and inconti- nence had begun to lessen, and when he reported to me at the end of that interval he was able almost completely to control the diminishing overflow. He had urinated only three times during the night. Gradual relief of the overdistended bladder was now begun. That night he rose but twice and had no incontinence. It never recurred. The next morn- ing, at my office, after he had voided four ounces as usual, four and a half ounces were drawn, empty- ing the bladder, thus establishing four and a half ounces as the initial residual. That night he uri- nated Trental 100 Mg but once. Three nights later he Trental 400 began to sleep through without urinating, and at the end of a week, after Trental Injection he had been taught to urinate in "edi- tions," the residual was found to be only two and a quarter ounces. Seven weeks later, when tested again, it was only one and a half ounces ; his diurnal intervals were two hours long on occasions, but three hours long as a rule ; there was no nocturnal urination and he had recovered his strength. Two weeks later when he reported, he could hold his urine four hours. This condition obtains to-day. The urethral length is 8j4 inches; the prostate, by rectum, is broad, flat, and moderately enlarged; the urine is sterile. In other words, this patient had complete reten- tion, overdistention,and incontinence, due to an acute congestion of his enlarged prostate, all of which disappeared under treatment, leaving him absolutely as well as before. Barring the first three weeks, he was Trental Indications not seriously incovenienced nor kept from busi- ness, and had the retention been recognized the mo- ment the incontinence developed or earlier, this period of three weeks would have been significantly shortened. The very prompt return of power to his detrusor is noteworthy. This result gives me satis- faction, and, considering the patient's temperament, environment, and lack of vigor, I think the satis- faction justifiable. To have operated would, I be- lieve, have exposed him to an unnecessary risk. Case III. illustrates a phase of catheter life that leads to a change of advice. V. L.. 60, married, when referred to me three years ago, gave the following history. For the past seven years he had been passing a soft rubber catheter once daily and irrigating regularly. He had gone along very comfortably holding his urine as long as seven hours, suffering only off and on from attacks of prostatitis and exacerbations of his chronic cys- titis. Ten days before his visit an unusually severe attack had developed with the usual symptoms — great frequency, some urgency, sharp tenesmus. 8i8 MEDICAL Pentoxifylline Trental RECORD. [Nov. 24, 1906 After a week he stopped passing his catheter on finding that the residual was only a very little instead of "the quart" he had been accustomed to draw. He had had urethritis thirty years before and syphilis "two or three times." His habits as to alcohol, to- bacco, and coffee were good. Examination showed a large man in fair general condition. He urinated a feeble, dribbling stream. A soft rubber catheter entered easily and found four ounces of residual urine. The prostate was large, full, boggy, and symmetrically ovoid, as felt by rec- tum ; it presented considerable intravesical enlarge- ment to the searcher. There was no calculus. The membranous urethra was narrowed to 25 F. After five days of preparatory treatment, includ- ing gradual dilatation of the membranous urethra, cystoscopy became possible and was performed. It proved the absence of calculus and demonstrated a large median lobe with considerable enlargement of the left as compared with the right. He remained under observation and treatment eleven days longer, then disappeared, the attack and exacerbation having so far subsided as to make catheterism only twice daily sufficient. The dilatation of the membranous urethra had reached only 29 F. Prostatectomy Purchase Trental was offered, but not urged ; the man's average comfort more than outweighing the very infrequent and tem- porary discomforts. He appeared a year ago complaining that all vol- untary urination had ceased, necessitating catheter- ism four or five times every twenty-four hours, in- cluding once at night, and that for the past three months he had suffered from recurring attacks of epididymitis. After five days of treatment under observation it was clear that catheter life in his own hands had come to an end. Perineal prostatectomy was per- formed, the intravesical outgrowth as estimated by searcher, cystoscope, and rectal touch not being so large as to demand the suprapubic operation, and a complicating calculus having been excluded. The patient made an uneventful recovery aside from a slight febrile movement the first three days and a mild phlebitis Order Trental Online later on in his long-standing varicose veins of the leg. The iodoform gauze pack- ing was removed the first day; the Trental Online tube at the end of forty-eight hours. He was up on the tenth day and left the hospital on the eighteenth. The perineal wound had closed permanently ; but he suffered a slight incontinence whenever the bladder became full, on which occasions he voided from eight to nine ounces, leaving a proven residual of three ounces. There was no nocturnal urination. Si.x days later he passed a small, black, irregular calculus with yel- lowish incrustations — undoubtedly a prostatic cal- culus that had been forced from its follicle during the prostatectomy.

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