. A manual of operative surgery . of the prostatic urethra, (3) acapsule of connectivetissue with a variableamount of circularmuscle-bands. A thinlayer of prostatic glandtissue is usually leftbehind with the fascialsheath of the prostatederived from the recto-vesical layer. It isthis intact fascial cap-sule which preventsextravasation of urineafter prostatectomy. As the prostate en-larges, its projectionis mainly upwards intothe bladder, hence theextent to which it bulges towards the rectum is a very imperfectindex to the total enlargement. Hence, also, enucleation fromabove the pubis is natur
. A manual of operative surgery . of the prostatic urethra, (3) acapsule of connectivetissue with a variableamount of circularmuscle-bands. A thinlayer of prostatic glandtissue is usually leftbehind with the fascialsheath of the prostatederived from the recto-vesical layer. It isthis intact fascial cap-sule which preventsextravasation of urineafter prostatectomy. As the prostate en-larges, its projectionis mainly upwards intothe bladder, hence theextent to which it bulges towards the rectum is a very imperfectindex to the total enlargement. Hence, also, enucleation fromabove the pubis is naturally easier than from the perineum. Inmany cases directly the anterior wall of the bladder is incisedthe projecting mass comes into view. The severity of the patients symptoms or the degree ofobstruction is not closely related to the size of the enlargedprostate. In some cases—fortunately the minority—the en-largement is mainly due to increase of fibrous and musculartissue. Thus a dense and comparatively fixed prostate of no. FIG. 177.—SECTION THROUGH THE PROSTATE GLAND. {After Testut.) :, Fibrous tissue and unstriped muscle forming a capsuleand sending in (2) septa between (7) the lobules 01glandular structure ; 6, Transverse muscle band belong-ing to the vesical sphincter; 8, Common ejaculatoryducts ; 3, Central area of connective tissue ; 4, Prostaticurethra (mucous coat) ; 5, Circular muscle of urethra ;9, Sinus, or utricle. 656 ABDOMINAL OPERATIONS [PART II great size is produced. Enucleation under such conditions ismore difficult and dangerous than when the gland is the seat ofcommon adenomatous hypertrophy. Should the surgeon afteropening the bladder find that the prostate is very tough, and thatattempts to enucleate it are attended with serious bleeding, hewill do wisely to content himself with a partial prostatectomy,removing the direct obstruction at the neck of the bladder by means of cuttingforceps. The relation of theprostatic urethra to theenlarged
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