. Surgery, its principles and practice . FlG. 234.—PosteriorRetractor. 444 SURGERY OF THE PROSTATE. verse bar which cannot be enucleated effectively with the blade of thetractor in the bladder. In such cases it is often wise to pick up thisportion of the prostate with a sharp hook through one of the lateralcavities, as shown in Fig. 237, and then to begin to separate first fromthe ejaculatory ducts which lie behind it and then from the urethrain front of it. After being partly freed it can be grappled with smallhemorrhoid clamps and removed with little difficulty, generally by bluntdissection,
. Surgery, its principles and practice . FlG. 234.—PosteriorRetractor. 444 SURGERY OF THE PROSTATE. verse bar which cannot be enucleated effectively with the blade of thetractor in the bladder. In such cases it is often wise to pick up thisportion of the prostate with a sharp hook through one of the lateralcavities, as shown in Fig. 237, and then to begin to separate first fromthe ejaculatory ducts which lie behind it and then from the urethrain front of it. After being partly freed it can be grappled with smallhemorrhoid clamps and removed with little difficulty, generally by bluntdissection, but sometimes with the aid of scissors. Removal of the medianlobe leaves a cavity communicating with two lateral cavities in front ofthe ejaculatory ducts, and behind the urethra. Insertion of the Finger into the Bladder.—It is next advisable to examinethe condition of the vesical orifice and sphincter with the finger, as it is. Fig. 235.—Enucleation or Lobes. Forceps in Position. not infrequent to find a sclerotic band around the vesical orifice. As arule, a linear tear has been made along one of the lateral walls of the ure-thra, and through this the finger can be introduced into the is often found to be tightly gripped, sometimes by a firm fibrous bandwhich requires considerable force before it will give way sufficiently toallow the finger to enter the bladder. In such cases it is well to thoroughlydilate the vesical orifice with the finger and with forceps. A carefulexamination should be made as to the conditions around the orifice,first to see whether the median portion of the prostate has been com-pletely removed, whether a bar or any valve-like structure remains tolead to subsequent obstruction to urination. The intravesical portionsof the lateral lobes should then be examined, and if any portion remainsit should be removed, using the finger as a tractor to draw forward and HYPERTROPHY OF
Size: 1688px × 1480px
Photo credit: © Reading Room 2020 / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bookcentury1900, bookdecade1900, booksubjectg, booksubjectsurgery
