The practice of surgery . verse, longitudinalor crescentic incision above the pubes. Then, ha^^ng seized the wallsof the bladder, he should open it by dissecting, when, with a fingerin the rectum elevating the prostate, that gland is brought immediately 422 GENITO-IIUNARY OHCiANS into touch with a finger entering the bhiddcr from above. The surgeonthen incises the mucosa over the tumor. It is now an (uisy matter toshell out the enlarged gland, which brings with it, usually, a portion ofthe prostatic urethra. Much has been said on the question of remov-ing the prostatic urethra, but the best ev
The practice of surgery . verse, longitudinalor crescentic incision above the pubes. Then, ha^^ng seized the wallsof the bladder, he should open it by dissecting, when, with a fingerin the rectum elevating the prostate, that gland is brought immediately 422 GENITO-IIUNARY OHCiANS into touch with a finger entering the bhiddcr from above. The surgeonthen incises the mucosa over the tumor. It is now an (uisy matter toshell out the enlarged gland, which brings with it, usually, a portion ofthe prostatic urethra. Much has been said on the question of remov-ing the prostatic urethra, but the best evidence shows that it is impos-sible to perform su]n-a]iubic prostatectomy without damaging theurethra. The after-history of these cases is so good, however, thatmany surgeons have come to feel such damage to the uicthra to be byno means permanent—indeed, to be negligible. The advantages ofsuprapubic enucleation are that the operation is done through a wideincision, that the danger to the rectum and membranous urethra is. Fi Hemostatic bulb and tube in place (J. 1 is). slight, and that the whole maneuver can be performed quickly. Hem-orrhage generally is inconsiderable. If the hemorrhage does not ceaseshortly with copious irrigation, one may well employ the hemostatictube or bulb devised by J. E. Briggs, and shown in the accompanyingcuts.^ After the removal of the prostate, thorough drainage should beestablished and continued for at least ten days. My custom is to placean inlying catheter in the urethra, and to sew a drainage catheter intothe bladder from above. I prefer to bring out the suprapubic drainagethrough the middle of the superior skin-flap, leading out with it at thesame time a gauze wick which shall drain the prevesical space. The1 J. Emmons Briggs, New England Med. Gaz., April, 1906. HYPERTUOrHY OF THE PROSTATE 423
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