Operative surgery . rable considera-tion. Pi/le gains ready and uneventful access to the prostate through aperineal incision similar to that employed in bilateral lithotomy (Fig. 14U2,(;).After division of the anal fasciae and separation of the fibers of the levatorani muscle, the prostate is exposed and enucleated. The Combined Method (Belfield).—The importance of the combinationof perineal and suprapubic manipulation in prostatectomy was first notedby Belfield. However, to Nicoll belongs the credit of maintaining the integ-rity of the mucous membrane of the bladder at the base, and thus pres
Operative surgery . rable considera-tion. Pi/le gains ready and uneventful access to the prostate through aperineal incision similar to that employed in bilateral lithotomy (Fig. 14U2,(;).After division of the anal fasciae and separation of the fibers of the levatorani muscle, the prostate is exposed and enucleated. The Combined Method (Belfield).—The importance of the combinationof perineal and suprapubic manipulation in prostatectomy was first notedby Belfield. However, to Nicoll belongs the credit of maintaining the integ-rity of the mucous membrane of the bladder at the base, and thus preserv-ing the perineal wound from vesical infection. The Operafion.~^npra\-mh\c cystotomy (page 1115) is first wall of the bladder is secured to the skin by five sutures—one at thelower angle—the mucous membrane is thoroughly cleansed, and the bladdercavity is partly .filled witli carbolic solution (one part in two hundred).The patient is then placed in the lithotomy position, and a sound or bougie. Fig. 1326.—The operation of lateral prostatectomy,Dittels method. Siring attached to gauze packingprotruding from anus. 1136 OPERATIVE SURGERY. is passed into the bladder and given to an assistant. With the left forefin-ger in the rectum, an incision is made in the perineal rhaphe and gradu-ally deepened without penetrating the urethra or the bladder until theapex of the prostate is reached. The rectum is carefully separated fromthe posterior surface of the prostate, and a vertical incision is made throughthe posterior and inferior part of the prostatic capsule. The capsule isgradually separated from the gland at either side by means of a periostealelevator or a like blunt instrument. The assistant meantime is pressingthe prostate down into the perineal wound with his fingers, introducedinto the bladder through the suprapubic opening. (If sufficient room forthe isolation of the prostate is not afforded by the median perineal wound,additional room may be obtained
Size: 1775px × 1408px
Photo credit: © The Reading Room / Alamy / Afripics
License: Licensed
Model Released: No
Keywords: ., bo, bookcentury1800, bookdecade1890, bookidoperativesurgery02brya
