Urologic Diseases

Classic disease descriptions

Through the exploration of classical books and writings of old-time clinicians, this growing database aims to provide categorized, detailed characterizations of diseases, including finely detailed signs and symptoms.

The symptoms of acute cystitis are the same, whether the affection be primary or engrafted upon an already-altered state of the local circulation. The calls to urinate are frequent and imperative, by night and day. The feeling of relief after micturition is absent. The act is accompanied by smarting pain, with tenesmus. Pain of heavy, burning character is felt in the perineum, and above the pubes, radiating thence, perhaps, to the end of the penis, to the loins and back, or down the thighs. The urine contains pus in greater or less quantities, at first evenly distributed through the fluid, then voided as stringy mucus (whence the name catarrh). Portions of bladder-wall may slough from the intensity of the inflammation, in which case the urine contains shreds of sloughy tissue, gases, etc., and has gangrenous odor. The reaction of the urine, at first acid or neutral, becomes alkaline. Triple and amorphous phosphates are found deposited in excess. Blood appears in the urine in greater or less quantities, perhaps pure and liquid, or in clots. There is rarely chill, but fever may run high, with all its accompanying symptoms, dry tongue, great restlessness, jactitation—hiccough, if gangrene be present. Mental inquietude, apprehension, anxiety and distress, are prominent features of acute cystitis, and are never entirely absent.

H., V. B., & Keyes, E. L. (1884). A practical treatise on the surgical diseases of the genito-urinary organs, including syphilis: Designed as a manual for students and practitioners. New York, NY: D. Appleton and Company.

Entered by: Kate Holder, 7/17/2020

This deformity is found in both sexes, but much more frequently in the male. In the female it is of less importance, as it may be more easily concealed, and does not prevent the performance of the sexual act. Cases of pregnancy and successful de livery at term are recorded. The subject will be considered here, however, only in relation to the male.

The deformity is an arrest of development in the median line, analogous to harelip, and is found in different degrees. In type case the lower part of the front wall of the abdomen and the front wall of the bladder are absent. The pubic bones are more or less widely separated from each other, their ends being united by strong band of fibrous tissue. The posterior wall of the bladder pressed out by the intestines, forms mottled, red, tomato-like tumor, occupying the position of the symphysis pubis. Inguinal hernia of one or both sides is not uncommonly present, either partial or extending down into the scrotum, which is usually normal, containing the testicles. The penis is more or less rudimentary and affected by complete epispadias. The ureters are sometimes greatly dilated, forming, as it were, rudimentary bladders. good illustrative case is figured by Sir Astley Cooper.

The above description applies to type case. There may be variations in the absence of hernias, normal union of the pubic bones, the amount of the protrusion, etc. Ordinarily in the adult the mass reaches the size of the palm. With complete exstrophy there is also always complete epispadias. condition analogous to exstrophy may exist where the bony union of the pelvis is lacking, but the anterior walls of the abdomen and bladder are perfect. Here there is sort of hernia of the bladder forward. In such cases there is always some anomalous condition of the external organs of generation.

In exstrophy of the bladder, the patient’s condition is miserable indeed. The thickened inflamed mucous membrane covering the protruded posterior wall of the everted bladder is constantly covered by decomposing stringy mucus of alkaline reaction, similar to what is found in vesical catarrh. From the orifices of the ureters, which can be readily seen by pressing back the protruded mass, there constantly distills limpid, acid, healthy urine. This at once becomes alkalinized by contact with the inflamed mucous surface of the bladder, and goes into rapid decomposition, wetting the patient’s linen and keeping him constantly surrounded by an atmosphere of ammoniacal, fetid gases, making him disgusting to himself and intolerable to his friends. The integument of the abdomen and thighs becomes excoriated and inflamed. The friction of garments in walking only serves to aggravate the existing difficulties, and the sufferer is in condition truly pitiable.

Entered by: Kate Holder, 7/17/2020

Another very rare complication of stricture analogous to infiltration is rupture of the bladder. This occurs in the same manner as the escape of urine from the urethra behind stricture. comparatively healthy bladder will not rupture from retention (unless, of course, mechanical violence is added—as fall). It will become immensely distended, and then be relieved by drops (overflow) through the urethra, the latter never being totally impervious to fluid, if time is allowed for inflammation and spasm to subside, and enough continued pressure is brought to bear upon it from within. In those rare cases, however, where sacculus has become thinned, or an ulceration exists, the bladder may give way under the pressure of distention from retention, and the urine escapes into the peritoneal cavity. The vesical tumor subsides. fatal collapse usually soon closes the scene. The urine may escape into the sub-peritoneal tissue, giving symptoms like those of infiltration behind the triangular ligament. The rarity of rupture of the bladder in connection with stricture is shown by the few cases reported. Thompson says he never saw it, and quotes Sir Everard Home as having observed only two cases. Pitha refers to case. The kidney or ureter might be ruptured in the same way through an ulcerated spot, as they are subjected to tension as great as that felt by the bladder.

Entered by: Kate Holder, 7/17/2020

Epispadias is fissure of the superior wall of the urethra with ectopia of the canal (Guyon). It is very rare. The urethral opening may be upon the glans, or anywhere along the top of the penis, as far back as its root. When the membranous and prostatic urethra are involved, there is also exstrophy of the bladder. The orifice of the urethra in epispadias is large. Sometimes finger may be passed through it into the bladder, that part of the urethra lying in front of the opening being an open gutter. Incontinence of urine is the rule, when the opening is far back. There may be complete epispadias without exstrophy of the bladder. Dolbeau has published an autopsy of this condition, with plate. The penis is short and thick in epispadias, or small and more or less deviated. The pubic bones are usually, but not necessarily, separated in complete epispadias. In such cases there may be hernia of the bladder, without positive exstrophy.

Entered by: Kate Holder, 7/17/2020

This deformity consists in an arrest of development of a portion of the lower wall of the urethra, its lateral halves failing to unite in the median line. The embryo at two months has hypospadias normally. The scrotum has not yet united, and, if natural evolution ceases here, the last degree of hypospadias results with bifid scrotum. Hypospadias may occur at any point in front of the membranous urethra but does not involve the latter or the prostatic portion of the canal; consequently, no matter how extensive hypospadias may be, the patient has control over the escape of urine.

Hypospadias, anterior to the peno-scrotal angle, is more common than the scrotal variety, and most frequent of all is hypospadias confined to the glans penis or its immediate vicinity. That part of the urethra lying between hypospadial opening and the meatus is usually absent or impervious, but may be patulous for short distance in front of the opening in the floor of the urethra, or even up to the meatus. Hypospadias, as commonly encountered in practice, consists of an absence of the froenum preputii, and flaring open of the meatus interiorly, or an inferior opening in the canal within few lines of the natural meatus, the position of which is usually marked more or less perfectly in its usual site. The glans penis may be bifid. The urethral orifice in hypospadias is small, as rule. The only disturbances caused by hypospadias are functional. The patient may not be able to pass water without wetting himself, as in scrotal hypospadias, and if the opening is too low in the canal, he may be impotent from inability to throw the semen against the uterine orifice. Simple hypospadias rarely calls for surgical interference, and operations which have been performed for its relief are not over-encouraging in their results —that is, in regard to restoring large portions of the canal.

Entered by: Kate Holder, 7/17/2020

True orchitis is very uncommon. As complicating mumps (so-called metastatic orchitis) no rational theory has been advanced to account for it. Observation abundantly proves that it occurs in at least five per cent, as complication of mumps in young adults, and the fact must be accepted without explanation. It has been noticed, indeed, during the prevalence of an epidemic of mumps, that cases of orchitis occur spontaneously in some patients whose parotids escape. Orchitis due to mumps is most often observed at about the age of puberty. It comes on near the end of the first week of the mumps and is usually confined to single testicle. The epididymis is perhaps also involved but may escape. The affection runs quick course of about week or ten days, very rarely terminates in suppuration, usually subsides without leaving any impairment of the organ behind but is sometimes followed by atrophy. Orchitis, after severe injury to the testis, is not uncommon. It tends to terminate in abscess or gangrene, and to be followed by atrophy, with loss of function of the organ. Orchitis as result of cold is possible.

Sometimes orchitis comes on in children, and even in adults, where no sufficient cause can be assigned. Excessive sexual excitement has been adduced as cause. Very rarely orchitis complicates variola or typhoid fever. low grade of true orchitis, located in the fibrous covering of the organ, is liable to attack gouty individuals. Orchitis may come on secondarily during epididymitis. Occasionally, especially in the old or enfeebled, true orchitis originates spontaneously in patients having chronic inflammatory urethral or prostatic disease.

lt advances rather slowly, and seldom becomes considerable until the affection has lasted length of time. This is accounted for by the unyielding nature of the albuginea, and the fact that there is usually no effusion into the tunica vaginalis. The pain is explained in the same manner. It is often excruciating, and always out of proportion to the amount of swelling. It has been compared to that of nephritic or hepatic colic. No position gives rest, and any handling of the organ is liable to induce syncope. The irritated cremaster contracts upon the sensitive testis and draws it up toward the groin. The pain continues high for several days, and then gradually becomes more bearable, or it may suddenly cease altogether. This last circumstance is gratifying only to the patient. The surgeon learns it with regret, for he knows that it means mortification of the organ.

The shape of the testicle is rarely altered in orchitis; it is smoothly, regularly ovoid. The epididymis is not distinguishable from the rest of the tumor. The organ feels peculiarly indurated, the natural elastic feel having entirely disappeared. The scrotal tissues are often red, swollen, edematous, inflamed. There is strong tendency to suppuration or mortification, the latter marked by sudden cessation of pain. The former is often announced by the occurrence of chill. After the chill the testicle commences to enlarge more rapidly, the scrotal tissues adhere to its surface, and, after -a period longer or shorter, according to the depth at which the matter forms, soft, fluctuating spot, surrounded by indurated borders, indicates clearly the position of the purulent collection. After the pus has escaped, all the severity of the symptoms abates, unless second purulent collection exists in some other part of the gland. The flow of pus gradually diminishes. As it decreases, the swelling subsides, and partial or total atrophy of the testicle ensues, with perhaps fistula remaining open for years. Sometimes exuberant granulations grow up out of the opening, forming cauliflower excrescence (hernia testis), which may reach considerable size, and, growing as it does out of an enlarged, hardened testicle, perhaps at this stage irregularly lumpy, and containing some softer spots, while at the same time the glands in the groin may become enlarged, hardened, and tender, and the general health decline—all this array of symptoms is very liable to give rise to suspicion of cancer—a suspicion which the result does not justify.

Entered by: Kate Holder, 7/17/2020

Primary cancer of the prostate is exceedingly rare. More usually it is secondary to advanced malignant disease elsewhere—especially in the kidney or testicle. As to the relative frequency of this disease, Tanchoil, out of 8,289 cases of fatal cancer, sets down only three for the prostate. Scirrhous, melanotic, and medullary disease, have all been noted; the latter most frequently. Cancer occurs chiefly in advanced life, sometimes as complication of already existing hypertrophy, and doubtless some of these cases have not been recognized. Medullary cancer, as primary affection, has been observed in the prostate of young children. Pitha saw one fatal case in stout man of thirty.

Symptoms.—The symptoms of cancer of the prostate are at first simply those caused by the increased size of the organ, obstruction to urination, frequency of the act, and pain. Increase in size does not occur as rapidly, or with as acute symptoms, as does inflammatory enlargement but more painfully and more rapidly than senile hypertrophy. When cancer becomes engrafted upon a hypertrophied prostate, its diagnosis during the early stages is impossible. The diagnosis with hydatids or cysts (dilated follicles—of quite common occurrence, but of no pathological importance) is made by the progress of the affection. The symptoms, then, of cancer of the prostate are not pathognomonic at first, but there are certain important aids to correct diagnosis. Thus, if the affection be scirrhous, the peculiar hardness will be significant; if medullary cancer, the enlargement felt through the rectum is usually less uniform than in hypertrophy, and certain spots may often be felt softer than others, sometimes amounting to feeling of deep fluctuation. The pain on pressure by the rectum is less decided than in inflammation, but more positive than in hypertrophy. The glands in the pelvis and in the groin sooner or later enlarge and assume cancerous characters. Hence the existence of obscure swellings along the course of the iliac vessels, felt through the abdomen, is an important aid to diagnosis. Cancerous cachexia is slow to appear. Its presence clears up any doubts which may have existed.

The importance of the existence of cancerous growths elsewhere is evident, and especially is this true of cancer of the testicle or kidney. The pain felt in cancer of the prostate is noticed largely in the rectum and about the sacrum, or radiating into the back, or down the thighs. Hemorrhage from the urethra is symptom liable to appear both early and late in this affection. The blood flows freely, is arterial in character, and often excessive in amount. It may appear spontaneously, or, more frequently, during urination. certain amount of relief to the symptoms is apt to follow such hemorrhage. The urine is troubled, purulent, often containing considerable debris of tissue. Sometimes shred of tissue of considerable size is passed or pulled away in the eye of catheter. From such shred diagnosis of cancer can sometimes be made by the microscope. Diagnosis based on finding so-called cancer cells in the urine is entirely unreliable. Retention is apt to occur from obliteration of the prostatic urethra by cancerous growth. In such cases catheterization is difficult and exceedingly painful, while the operation is pretty sure to provoke considerable bleeding. Hypertrophy of the bladder with dilatation, and perhaps stone, may come on, as in other obstructive prostatic disease. The duration of the disease is set down, from first appearance of symptoms to fatal termination, at from one and half to five years for adults, three to nine months for children.

Entered by: Kate Holder, 7/17/2020

They are visible with the microscope at any time after puberty, but do not attain considerable size until adult or advanced age. Thompson has described them minutely. They are not to be confounded with stone of urinary formation. They are often found of very small size in the voided urine. In such cases they have no pathological significance. During their forming stage (when they measure from the one-thousandth to the one-hundredth of an inch) they appear under the microscope of an oval or slightly angular form, of pearly luster, and in varying shades of light-yellow color. This color increases in the larger concretions to deep orange. They have cellular appearance, but no nucleus, and, as they become larger, exhibit concentric rings of different thickness. Often, in the larger concretions, many of the smaller bodies seem to have been lying together, and to have become surrounded by concentric layers of yellowish material to form one mass. Often, lines are seen radiating from the center toward the circumference, and in the direction of these lines’ cleavage takes place, when the masses are subjected to pressure. When young they are very soft, but, as they increase in size, they become exceedingly hard and stony. The young cell-like bodies are not affected by acids, or alkalis, or ether; but the larger dark bodies are rendered somewhat more translucent by alkalis, while the mineral acids (especially sulphuric) usually occasion liberation of bubbles of gas (carbonic acid) and some shrinkage in size, sometimes disintegrating them into mass of amorphous matter, which still retains its color and bulk

Entered by: Kate Holder, 7/17/2020

Prostatic enlargement may exist for a long time to a limited extent without producing any symptoms that direct attention to the genitourinary tract. [...] There may be retention of urine; there is always in such a condition more or less residual urine in the bladder. [...] retention, and thus distention of the bladder is a constant result of an enlarged prostatic gland.

In the mildest form of chronic enlargement, the old man notices that he micturates oftener during the day than he used to, and that he has to rise a little earlier in the morning on account of a pressing desire to urinate. There is a sense of uneasiness, or actual pain of a stinging kind, extending along the penis, felt more especially at the glans. He has to wait a little time before the flow begins, and more or less straining is always necessary to start it; then it comes slowly and cannot be projected in a jet; indeed, it usually falls nearly perpendicular from the urethra. After he thinks the act is complete, several drops pass. [...] The stream is always small. After a time he is compelled to evacuate the bladder every hour or two, or there may be a continual dribbling, especially marked when the patient is in a recumbent posture.

There is no sense of satisfaction after micturition; and just here it may be mentioned that, when excessive prostatic enlargement exists, there is a sense of incomplete evacuation of the rectum, and tenesmus is occasionally present at stool. For the same reason, hemorrhoids and prolapsus ani are by no means infrequent coexisting conditions.

Any slight indiscretion in eating and drinking may bring on an attack of retention. All violent or jolting exercise, such as horse-back riding, increases the desire to micturate, and may cause slight pain along the course of the urethra, together with flying pains in the hips, limbs, and about the pubis. [...]

In the severer form, the bladder is exceedingly irritable; a sense of weight and fulness is experienced in the perineum; retention soon follow, the other symptoms being those of the milder variety. The efforts made to expel the urine are often so severe that various portions of the mucous membrane weaker than the rest, are pressed out, and sacculation of the bladder is the result. The urine decomposing in these sacs is one of the most favorable conditions for the formation of stone. When the outflow has been obstructed for some time, [...] there is usually a mild or severe chronic catarrh of the ureters and calices and pelvis of the kidney. Sometimes the bladder hypertrophies and contracts, instead of becoming distended; then irritability of the bladder becomes a marked and constant symptom. [...]

The first changes in it are a fetid smell, and the presence in the secretion of viscid, stringy mucus. As the disease progresses, more and more of residual urine is left in the bladder, and we find it dark and mingled with gummy mucus. When vesical catarrh is present, the urine may have an almost milky appearance, from admixture of pus, and possess a horribly fetid and ammoniacal odor. It is rare to find the urine of an old man with enlarged prostate that does not contain pus-globules, blood-corpuscles, amorphous urates and prostates, mingled with crystals of the triple phosphates and stringy mucus.

Charcot, J.M. & Loomis, A.L. (1881) Clinical Lectures on the Diseases of Old Age. W. Wood & Company. Pg. 259.

Entered by: Ayushi Chintakalaya, 6/18/2020

The varicocele is a dilatation of the blood-vessels of the scrotum. These are of different size, in different people; and, like the vessels in other parts of the body, are liable to become varicose; but are seldom so much enlarged as to be troublesome, unless such enlargement is the consequence of a disease, either of the testicle, or of the spermatic chord.

Pott, P. (1819). The Chirurgical Works of Percival Pott. (pp.114). Philadelphia, Published by James Webster; William Brown, printer.

Created by: Sara Ahmed, 06/14/2021

Entered by: Rachel Johnson, 08/29/2021