. Studies on hypertrophy and cancer of the prostate. or a lobule which has been left behind can usuallybe discovered. When there is no median bar or lobe to hold up the intravesical por-tion of the prostatic tractor, the blades may slip beneath prominentintravesical lateral outgrowths, as shown in Pig. 36. This happenedin one of my early cases and is the cause of an imperfect result. Eo- study of 145 Cases of Perineal Prostatectomy. 39 tation of the tractor and palpation with the finger, as described above,should prevent such an oversight. In rare instances it may be neces-sary to use the inde
. Studies on hypertrophy and cancer of the prostate. or a lobule which has been left behind can usuallybe discovered. When there is no median bar or lobe to hold up the intravesical por-tion of the prostatic tractor, the blades may slip beneath prominentintravesical lateral outgrowths, as shown in Pig. 36. This happenedin one of my early cases and is the cause of an imperfect result. Eo- study of 145 Cases of Perineal Prostatectomy. 39 tation of the tractor and palpation with the finger, as described above,should prevent such an oversight. In rare instances it may be neces-sary to use the index finger in the urethra in place of the tractor,particularly in small pedunculated middle lobe cases, as describedabove. Whenever one fails to find what has been shown by the cysto-scope the digital exploration should be employed. The only objectionto it is that the urethra is usually split open by the procedure. Drainage.—Before withdrawing the tractor a careful examinationshould be made bv inserting the fino-er into both of the lateral cavities. Fig. 37.—Scheme of continuous irrigation apparatus. and palpating the blades through the vesical mucosa, in order todetermine that no important glandular mass has been left tractor is then removed by first rotating the blades until theycome together and then withdrawing the instrument. Abundant ves-ical drainage should be provided, as a small tube may easily becomeplugged by blood-clots and give great annoyance afterwards. I now use two catheters of fairly good size. These are fastenedtogether by ligatures and are prepared before the operation, so thatas soon as the tractor is withdrawn they can be inserted through theperineal wound into the urethra and bladder. In order to facilitatetheir introduction it is best to cut obliquely across the end of each 40 Rugh H. Young. catheter and then fasten the cut surfaces together with a single suture,thus making a common point for the two catheters. If this is notdone one of the
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectfistula, bookyear1906
