A consideration of prostatic obstruction and the treatment for it entails: first, an analysis of the variation from normal function of the posterior urethra, internal sphincter, trigon and wall of the bladder; second, a consideration of how the type and location (relative to the internal sphincter) of the obstructing mass may bring about such variation and so specifically alter the action of these parts as to account for the marked dissimilarity in individual cases with regard to symptoms, infection, both local and generalized, and renal and secondary systemic changes.
If the onset is with prostatitis in early middle life scar tissue formation followed by adenomatous changes occurs, and symptoms of irritability precede those of obstruction. In this type, the scar tissue change is frequently the primary obstructing factor, associated or not with later adenomatous changes. The second classification includes those cases in which there are adenomatous changes with secondary infection
ROSE DK. CHANGES IN THE WALL OF THE BLADDER SECONDARY TO PROSTATIC OBSTRUCTION: THEIR SIGNIFICANCE IN PROSTATIC SURGERY. Arch Surg. 1932;25(4):783–795. doi:10.1001/archsurg.1932.01160220171006
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