The Functional Results of Perineal Prostatectomy *

All prostatic surgeons hitch their operative wagon to the proverbial star of a perfect functional result. That is a commendable effort. For the treatment of prostatic obstruction there are three surgical procedures, all of which are admitted to have merits. Some patients obtain an equally good functional result from any one of the procedures, but perfect functional results can not be obtained from the indiscriminate application of one procedure to all cases. Some patients arrive too late to obtain a perfect result, no matter what surgical procedure is applied. The fact that there are three recognized procedures implies that each, if applied under certain conditions, has value above the others. Hence a clinic which does only one type of operation can not, theoretically, obtain perfect functional results unless the cases be selected. The functional results of perineal prostatectomy have been compared frequently with the results of the suprapubic and transurethral operations. The author ventures to predict that some time in the near future discussions relative to functional results will not be concerned with the results of any one procedure but will deal with the results of the three surgical procedures in a comparable group of cases. The success of a surgical operation is commensurate with the permanent functional result. All prostatic surgeons aim to give the patient a bladder which will empty, a bladder with a normal capacity of 500 cc., a bladder which will eventually be free from infection, and a urinary stream which can be controlled. The maintenance of the sexual faculties is important when they persist and are exercised in the prostatic age. There is, then, no argumentative factor as to what constitutes a perfect result. All patients are not alike, and the clinical factors show great variation. Prostatic enlargement may or may not be associated with complications of a minor or major degree. The operative risk is proportionate to the severity of the complications. Prostatic tumors may grow intra-urethrally, extravesically, intravesically, or in any combination of these ways. Complications such as infection, bladder