Tuesday, May 20, 2014

Historical Contribution: 1930, Andres, Medical Aspects of... BPH


Andres EC.  Medical Aspects of the Treatment of Benign Prostatic Hypertrophy.  Amer J of Surgery. 1930;9;3:502-6.

By the 1930's it was well established that benign prostatic hypertrophy (BPH, now known as benign prostatic hyperplasia) was the leading cause of urinary obstruction in elderly men, requiring intervention in nearly 85% of these men.  The progression of BPH was well-established, from changes in the bladder leading to retrograde changes in the ureter, kidney and eventually the nephrons.  Andrus astutely noted that progressive renal deterioration was due to the back pressure of urine, recurrent infections and underlying renal disease in this elderly population.

Interestingly, Andres made the observation that patients with progressive urinary obstruction due to BPH also had dramatic effects on their cardiovascular system.  He noted that patients were often clinically fluid overloaded and their hearts suffered through this with compensatory left ventricular hypertrophy and fibrotic changes in the aorta.

To combat these cardiovascular changes, Andres recommended that patients rest, make changes to the diet, and keep hydrated to prevent the effects of azotemia.  If unable to tolerate oral hydration, "A siIver cannula is inserted into a superficial vein, usually on the foot,and is tied in pIace. Through this normal saIt soIution is injected continuously, reguIated by a drop device quite simiIar  to the Murphy drip so that the patient receives not more than IOO to 200 C.C. per hour. In this fashion Iarge amounts of fluid may be given over a period of days and so sIowIy that the circulation is not embarrassed thereby."

In addition, Andres recommended digitalis to stabilize the myocardium and an operation if the obstruction was refractory to the conservative, medical treatments described above.

In summation, Andres depicted the comorbid conditions (specifically cardiovascular) common in the elderly man presenting with obstruction from BPH.  He defined a management algorithm that progressed from acute stabilization, laboratory evaluation, medical treatment and finally surgery if needed.

Finally, Andres, a medical doctor at Johns Hopkins offered the following acknowledgement:
The author desired to express his appreciation to Dr. Hugh H. Young for permission to follow these cases on his service, and to acknowledge with thanks the assistance of the staff of the Brady Urological Institute.
To read the entire manuscript click on the title above or click here.

HISTORICAL CONTRIBUTIONS highlight the greatest academic manuscripts from the Brady Urological Institute over the past 100 years.  As the Brady Urological Institute approaches its centennial, we will present a HISTORICAL CONTRIBUTION from each of the past 100 years.  In the most recent experience, the most highly cited article from each year is selected; older manuscripts were selected based on their perceived impact on the field.  We hope you enjoy! 


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