. Surgery, its principles and practice . er, is very rare. j\Iore com-monly we find an enlargement on both sides of the urethra, whichis flattened between them and ^ lengthened antero-posteriorly, as ^^ seen in Fig. 216. In such cases ,h t^ the prostate is usually increased / \ in all of its diameters, but atoperation only two globularmasses, which are composed ofnumerous spheroids, are found;one on each side of the such cases that portion of theprostate beneath the urethra andthe ejaculatory ducts is rarelyenlarged. In the earlier stagesthe enlarged lateral lobes do notproject into
. Surgery, its principles and practice . er, is very rare. j\Iore com-monly we find an enlargement on both sides of the urethra, whichis flattened between them and ^ lengthened antero-posteriorly, as ^^ seen in Fig. 216. In such cases ,h t^ the prostate is usually increased / \ in all of its diameters, but atoperation only two globularmasses, which are composed ofnumerous spheroids, are found;one on each side of the such cases that portion of theprostate beneath the urethra andthe ejaculatory ducts is rarelyenlarged. In the earlier stagesthe enlarged lateral lobes do notproject into the bladder, but inrare instances they project ante-riorly toward the symphysis pubis, greatly increasing the antero-posterior diameter of the prostate, butforming a prostate the size of which is not indicated either on rectalexamination or with the cystoscope (I have seen two such cases). As arule, however, enlarged lateral lobes soon begin to project into the bladder,where they appear as globular outgrowths covered with smooth mucous. ,^.\^iS Fig. 216.—The Hypertrophy Here is Ad-vanced Still Further Than That Seenin Figs. 214 and 215. Tlie central portion is entirely replaced bythe hypertrophied tissue, wliile the peripheralportion assumes the role of a thickened capsulein the periphery. The ejaculatory ducts areseen toward the posterior surface. HYPERTROPHY OF THE PROSTATE. 413 membrane, but with no intervening layer of muscle. Dissection in suchcases shows that the vesical sphincter lies external to these outgrowths,which have evidently grown into the bladder from the urethra, thus dilatingand pushing the vesical sphincter outward. This is an important point,because it allows the enucleation of these lateral enlargements withoutthe desti-uction of the vesical sphincter. The size reached by such lateralenlargements is often very considerable and occasionally huge. I haveseen cases in which the lateral lobes projected far into the bladder, sothat they presented the appe
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