. Operative surgery, for students and practitioners . mes verythin, is carefully peeled away from this part of the gland, eitherbluntly with the finger or blunt dissector or else, if necessary, withthe assistance of the knife. In this way the lobe is finally shelled outof its sheath. These procedures are repeated on the other side and thesecond lobe removed in a similar manner. Occasionally, if the con-nective-tissue interval between the prostate lobe and its sheath and theurethra is not well pronounced the enucleation of the lobe is difficultor impossible, and in order to remove the gland it
. Operative surgery, for students and practitioners . mes verythin, is carefully peeled away from this part of the gland, eitherbluntly with the finger or blunt dissector or else, if necessary, withthe assistance of the knife. In this way the lobe is finally shelled outof its sheath. These procedures are repeated on the other side and thesecond lobe removed in a similar manner. Occasionally, if the con-nective-tissue interval between the prostate lobe and its sheath and theurethra is not well pronounced the enucleation of the lobe is difficultor impossible, and in order to remove the gland it may be necessaryto drag it out through the incision in its sheath, piece by piece, cuttingthem away, and thus remove it piecemeal. After the extirpation has been completed the prostatic urethrawill be found b^ggy, sacculated, and the finger can be introducedthrough it into the bladder without meeting any obstacle. Search forstones, which are frequently present, should be made. Even largerstones can be removed through the roomy prostatic urethra. The. Fig. 217.—Perineal Prostatectomy. The sheath of the prostate hasbeen opened and partly detached from both lobes and is drawn asidewith tractors. The prostate body has been split in the middle lineand the prostatic urethra opened from the membranous portion, justbehind the bulb, backward, upon the metal sound within the right lobe of the prostate, grasped with a vulsella, has beenalmost completely euucleated. OPERATIONS UPON THE PROSTATE. 503 redundant edges of the prostatic urethra are trimmed off and unitedwith catgut sutures over a rubber catheter introduced through theurethra or else the opening in the urethra may be left partly open anda rubber catheter introduced into the bladder through the edges of the empty prostatic sheath are trimmed away. Bleeding during the operation is usually not excessive unless thesheath is firmly adherent to the prostate, and then the detachment maybe accompanied by consi
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