. Surgery, its principles and practice . in the median line of the abdomen, anda vesical incision about an inch long made in the vertical direction towardthe symphysis. On withdrawal of the scalpel the forefinger is introduced HYPERTROPHY OF THE PROSTATE, 435 into the bladder, and if any calculi are present they are at once removedby forceps or scoop. The forefinger of the other hand is then introducedinto the rectum to render the prostate prominent in the bladder, and toto keep it steady during the manipulation by the first hand. The mucousmembrane over the most prominent portion of one later
. Surgery, its principles and practice . in the median line of the abdomen, anda vesical incision about an inch long made in the vertical direction towardthe symphysis. On withdrawal of the scalpel the forefinger is introduced HYPERTROPHY OF THE PROSTATE, 435 into the bladder, and if any calculi are present they are at once removedby forceps or scoop. The forefinger of the other hand is then introducedinto the rectum to render the prostate prominent in the bladder, and toto keep it steady during the manipulation by the first hand. The mucousmembrane over the most prominent portion of one lateral lobe or overthe so-called middle lobe is scored through by the sharpened finger-nailand gradually detached by it from the prominent portion of the prostatein the bladder. This portion of the enlarged prostate is covered merelyby mucous membrane, so that when it is scraped through and detachedthe true capsule of the prostate is at once reached. Keeping the fingerspoint in close contact with the capsule, the enucleation of the prostate. Fig. 228.—Suprapubic section of pelvis, showing finger enucleating the prostate from its sheath, as counter-pressure is made by the other hand in the rectum (after Deaver, modified). out of the enveloping sheath outside of the bladder is proceeded with byinsinuating the finger-tip in succession behind, outside, in front of onelateral lobe, thus separating the capsule from the sheath. The finger isthen swept in a circular fashion from without inward, in front of and tothe inner side of the lobe, detaching this from the urethra, which is feltcovering the catheter, and is pushed forward toward the symphysis betweenthe lateral lobes, which will, as a rule, have separated along their anteriorcommissure in the course of the manipulation. The other lobe is attackedand treated in the same manner. The finger is next pushed well downwardto the prostate and the inferior surface of the gland is peeled off freewithin its sheath and
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