The most frequent complication of prostatic hypertrophy is the infection of the bladder (cystitis). In some cases it develops even in the first phase, before there is any retention of urine at all, but in nearly all cases characterized by a chronic retention, the cystitis is present. It may be due to the most various causes.
In cases, never having been treated locally and never having been examined by passing any instrument into the bladder, we must suppose, that the microbes circulating in the blood vessels or from the urethra or perineum reach the bladder, its congestion and hyperaemia being favourable to their development. Whereas in cases in which a cystitis develops following catheterizing, there can be no doubt, that the microbes have been carried into the bladder with the instrument. Certainly by proper and careful sterilization of the catheters we may prevent the bladder’s infection, but, if the catheter has to be used for a longer period as in cases of a chronic retention, there can be no doubt, that in spite of the utmost precaution cystitis will develop. Owing to this “residual” urine its cure is difficult. Such a cystitis may be accompanied in many cases by an urethritis or even an inflammation of the testicles. Furthermore I must call attention to the inflammation of the prostate itself (prostatitis), always being a more or less serious condition, because it may be fatal.
Stones in the bladder are one of the most frequent complications; most of these stones are phosphates, they develop around the mucus and pus of the residual urine; in some cases they do not cause any serious symptom, but in others cause pain and even haemorrhage develop. We are confronted with haemorrhage in may cases, where no stone is present. Such a haemorrhage may be the consequence of a congestion of the blood vessels and rupture of them, due to an acute retention. Each haemorrhage is a very serious complication, the more so, as it often is followed by a complete stoppages of the urinary flow; the bladder may be completely filled with big blood clots, blacking the opening of the bladder. Such haemorrhages may continue for several days. They arise either from the kidneys. Furthermore I must refer to the haemorrhages, following the introduction of a catheter; these haemorrhages are of the greatest importance. It is easy to understand, that if the catheter damages the tender and congested tissue of the urethra prostatica even only slightly, a severe haemorrhage may be provoked. But there are cases, in which the catheterism is followed by a severe haemorrhages, though the catheter did not hurt the urethra or prostate at all. These are haemorrhages from the bladder veins themselves; we call these haemorrhages “ex vacuo.” The explanation for these haemorrhages is clear; the bladder having been for a long time influenced by the high pressure of the retained urine, suddenly gets rid of that pressure by drawing away the urine. Consequently the weak blood vessels too suddenly fill up with blood, leading to a rupture of their diseased walls.
Finally I must mention the ascending purulent infection of the kidneys and their pelves as a most serious and fatal complication. Certainly not all cases of bladder-infection are ascending. I know of a great number of prostatic patients who have been suffering from infection of the bladder for over ten years without any involvement of their kidneys. But as soon as the kidneys are affected, the most alarming symptoms arise: rapidly progressive and increasing general weakness, loss of appetite, immense thirst, tongue very dry, scaly, coated, it really cleaves to the cavity of mouth, the patient being unable to move it. The patient may die under progressive cachexia. Such a chronic infection (urosepsis), sometimes accompanied by slight fever, is much more dangerous than an acute infection. To such an acute infection the organism replies with high temperature and reactions which purify the blood and after a couple of days entirely recovers, whereas in cases of a chronic infection a recovery is the exception. A chronic infection affects the urinary organs, the blood vessels and the whole condition of the patient. There are cases characterized by fever and disorders of the digestive organs, or with cerebral symptoms, while others again are without any fever at all, but these chronic cases are most serious and too often fatal as the disease progresses. The septic character of the disease may have been for a long time latent, but, as soon as symptoms of the urinary organs appear, the true nature of the condition is easy to diagnose. In the great majority of these patients there are already very serious disorders of the whole organism, before and symptoms affecting the urinary organs appear.