Prostatism is caused by one of three conditions: median bar, hyperplasia or cancer. It is treated by one of three routes: the transurethral, the suprapubic or the perineal. This trebleness of kind and approach is confusing and a cause of contention. To differentiate a median bar from hyperplasia, either of which may be associated with cancer, and to recognize cancer when it occurs alone as well as when it is so associated is the problem of diagnosis. None of the three conditions can be cured without surgical intervention. To treat each kind of prostatism therefore by a transurethral, a suprapubic or a perineal operation is the choice of surgery, at least in theory. This reasoning may be false, since it is not followed in every practice. Some surgeons never choose a twofold or threefold plan of treatment but fit one method to all conditions. It follows that the diagnostic problem
HINMAN F. THE PERENNIAL DISPUTE IN THE TREATMENT OF PROSTATISM: CLINICAL LECTURE AT SAN FRANCISCO SESSION. JAMA. 1939;112(5):424–430. doi:10.1001/jama.1939.62800050003010
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