Excerpt from Papers Published During 1914

By the term "prostatic hypertrophy" is understood a non-inflammatory enlargement of the prostate gland, which is more or less uni
form in size. The time of life at which this enlargement usually makes its appearance is from fifty to seventy years of age, and the most serious complication, in feet, the condition which causes practically all the symptoms, is a marked impairment of the function of the bladder.

It is not a true hypertrophy. because even in the earliest stages the microscopical structure of the gland is altered. Nor is it a tumor, but rather an adenomatous growth of the fibrous variety, which spreads upward under the mucous membrane until it reaches the bladder. Two definite and distinct types of enlargement occur. In the one - a pseudo adenomatous gland - there is a marked increase in the glandular elements, while in the other there is a conspicuous increase in the stroma of the organ. These two conditions may occur independently of each other, or they may co-exist in the same organ.

The hypertrophied prostate sometimes reaches an enormous size. Any gland weighing over six drachms may be considered abnormally large, though not necessarily causing any symptoms whatever. A gland as small as eight, or even six drachms may be the cause of retention of several ounces of urine, while one weighing even many times as much may be productive of but very mild symptoms. The size and weight of the organ depends materially on the amount of fibrous tissue present. The more fibrous tissue the greater the weight, though the size may not necessarily be correspondingly increased.

The greatest enlargement invariably takes place in the antero-posterior direction, and while neither lateral lobe is found to be constantly larger than the other, yet it is uncommon to find them of equal size. Even in the cases of greatest hypertrophy there is but seldom any enlargement of the so-called middle lobe, when such a projection does occur, it will usually be found to have its attachment to one or other of the two lateral lobes.

Next in importance to the size and weight of an enlarged prostate is a consideration of the density. The greater the amount of fibrous tissue present the greater will be the density - so much so that, in some instances, the gland will appear to have almost the consistency of leather.

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