The Prognosis. The acute form usually disappears within a fortnight and a seeming cure may sometimes be secured; but the outlook, as in all gonorrhoeal processes, cannot be altogether favorable. Occasionally there is a fatal termination from rupture of the suppurating sacs; but more commonly a low grade of chronic inflammation persists, which is liable to recrudesce with every fresh infection or with every redevelopment of the original attack, and with each succession of the relapses the gravity of the condition is increased.
Inflammation of the prostate is a rather common complication of gonorrhoea which not infrequently ends fatally sometimes rapidly, but more often remotely.
The prostate gland is situated at the very beginning of the urethra, completely surrounding it as well as the neck of the bladder. Posteriorly it lies in close contact with the walls of the rectum. In size and shape it resembles a horsechestnut, having the base directed toward the bladder and the blunt apex looking forward. It is partly muscular and partly glandular in structure, the whole organ being invested with a firm, fibrous, unyielding capsule.
It consists of three distinct lobes, the two larger being placed laterally and the smaller one between them on the under surface. Three canals run through it, the urethra perforating it above and the two ejaculatory ducts piercing it obliquely to open into the prostatic portion of the urethra.
The prostate, though containing numerous involuntary muscular fibres, is chiefly composed of glandular tissue, which pours out a fluid of a milky color, of the consistence of a rather weak solution of gum arabic. This prostatic fluid, which is conducted to the urethra by from twelve to twenty minute excretory ducts, serves to lubricate the mucous membrane of the urethra and also is a natural vehicle for the semen.
The organ has a rich supply of blood vessels, lymphatics and nerves, the latter, derived from the sympathetic nervous system, being extremely sensitive.
Being so intimately associated with the posterior urethra and communicating with it so freely by means of these numerous ducts and passages, it is not to be wondered at that the gonococci readily invade it and produce untoward results which have a tendency to remain chronic indefinitely.
Prostatitis may result from external injuries, from exposure to damp and cold, or from immoderate exercise on an improper saddle; but it is usually a complication of gonorrhoea after it has spread to the posterior urethra. Occasionally it rapidly follows an acute gonorrhoea of the anterior urethra, especially if the abortive method has been unwisely tried, or if a catheter has been passed too early and has carried the virus down the urethra.
Sometimes the results are hardly apparent, but usually the prostate is left in a damaged condition and rendered a scarred, shrivelled mass with little or no glandular structure.
Symptoms. Being, as a rule, a complication of posterior urethritis, which ordinarily does not develop until after the third week of the infection, prostatitis is not to be expected very early in the course of the disease. The symptoms begin with a dull pain and a sensation of weight in the perinseum. There is difficulty in urinating and a desire frequently to empty the bladder. A sense of fulness is felt in the rectum which gives rise to frequent calls to go to stool, and often there is a tenesmus of both the bladder and rectum which compels the patient to make the attempt to void his urine and faeces, but without success.
Sometimes urination is an impossibility, so that relief must be given by catheterization. Owing to the swollen condition of the prostate and the consequent pressure on the neck of the bladder and urethra, there is great danger that a portion of the urine will be retained and set up severe bladder and kidney complications by its decomposition. If inflammation of the epididymis and seminal vesicles be superadded, the patient's sufferings will be much aggravated.
Sometimes the enlarged prostate impinges on the rectum so as almost completely to block up that passage and prevent defecation. These symptoms may be further aggra
vated by an increased sexual excitability, with erections and pollutions, on account of the inflammation of the veru montanum, which is situated in the prostatic portion of the urethra, and is the chief seat of sexual desire. Few conditions of disease cause so much suffering and agony as a severe inflammation of the prostate the constant desire to urinate and defecate, the throbbing pains and the general constitutional and mental disturbance punishing the patient with the greatest distress and anguish. Prognosis. The affection is always exceedingly painful and the dangers grave. The process may abate in three or four weeks, but it is liable to pass into an obstinate and chronic condition which keeps up a persistent sexual neurasthenia and irritability.
If an abscess form, and if it be not early operated upon by the surgeon, it may result in pyaemia, septicaemia and death, or it may form a recto vesical fistula, in which case there is a free vent between the bladder and rectum. Such a fistula is exceedingly difficult to heal; and the patient, continually dribbling urine from his rectum and being constantly pervaded with a strong urinous atmosphere, is an object of aversion to every one about him. If there have been extensive suppuration there will be a serious and permanent damage to the urinary tract; the former site of the prostate being occupied by a shrivelled, hardened and scarlike mass.
The prognosis is more serious in those who have a poor constitution, and in those individuals whose will power fails to restrain them from venereal excesses or indulgence in alcohol.