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CLINICAL NOTES

Prostate Examination

The prostate can be examined clinically by palpation by perform- ing a rectal examination (see page 311). The examiner’s gloved finger can feel the posterior surface of the prostate through the anterior rectal wall.

Prostate Activity and Disease

It is now generally believed that the normal glandular activity of the prostate is controlled by the androgens and estrogens cir- culating in the bloodstream. The secretions of the prostate are poured into the urethra during ejaculation and are added to the seminal fluid. Acid phosphatase is an important enzyme pres- ent in the secretion in large amounts. When the glandular cells producing this enzyme cannot discharge their secretion into the ducts, as in carcinoma of the prostate, the serum acid phospha- tase level of the blood rises.

cae, located at the neck of the bladder. The leakage of urine into the prostatic urethra causes an intense reflex desire to micturate. The enlargement of the median and lateral lobes of the gland produces elongation and lateral compression and distortion of the urethra so that the patient experiences diffi- culty in passing urine and the stream is weak. Back-pressure effects on the ureters and both kidneys are a common com- plication. The enlargement of the uvula vesicae (owing to the enlarged median lobe) results in the formation of a pouch of stagnant urine behind the urethral orifice within the bladder (Fig. 7.17). The stagnant urine frequently becomes infected, and the inflamed bladder (cystitis) adds to the patient’s symptoms.