Inasmuch as the prostate is to be regarded as essentially a sexual gland, many cases of hypertrophy are the result of bad sexual habits which produce continued congestion. Nevertheless the importance of previous infections, e. g., gonorrheal, by which hypertrophy of glandular and cell elements may be produced, cannot be overlooked.
Prostatic enlargement assumes one of three principal types:
- (a) True hypertrophy of gland elements, without interstitial participation;
- (b) The development of more or less distinctly encapsulated myomatous and adenomatous masses; and
- (c) A mixed condition involving both of these features.
In consequence the ensuing enlargement assumes one of the three following clinical types:
- (a) An enlarged soft prostate;
- (b) A small contracted and sclerotic prostate;
- (c) A mixed type.
These types do not necessarily merge into each other, but may remain distinct. There may be atrophy of glandular elements as a result of hypertrophy of the muscle and fibrous elements, or vice versa.
Much confusion has arisen regarding the so-called third lobe, in spite of the fact that the prostate is essentially a bilobed organ. Whence has arisen the tendency to speak of the “third lobe,” or is there such a thing? The explanation is that median enlargement is a common expression of prostatic hypertrophy, occurring toward the interior of the bladder at a point where the prostate has no capsule, and where growth occurs in the direction of least resistance. That morbid specimens show an apparent “third lobe” is true, but that such a condition exists normally is a mistake. It should, therefore, be spoken of as a median enlargement ([Fig. 659]).
Fig. 659
General prostatic enlargement, with formation of a median overgrowth and posterior pocket or sac. Illustrating how residual urine may be retained, as well as the difficulties of all kinds of instrumentation, i. e., an argument, therefore, for radical treatment. (Socin and Burckhardt.)