The practice of surgery . erators to-day, and it has done so for the past ten years. \ig-orous exponents of the suprapubic and of the perineal routes are still inconflict. It is not reasonable that such conflicts should continue. Anysurgeon familiar with both operations will admit that each has its place. HYPERTROPHY OF THE PROSTATE 421 Those enlarged prostates which encroach Uttle upon the rectum andperineum, but project far into the interior of the bladder, are moreeasily attacked from above by the average operator, so that for thosecases I advocate the suprapubic operation except for the ex
The practice of surgery . erators to-day, and it has done so for the past ten years. \ig-orous exponents of the suprapubic and of the perineal routes are still inconflict. It is not reasonable that such conflicts should continue. Anysurgeon familiar with both operations will admit that each has its place. HYPERTROPHY OF THE PROSTATE 421 Those enlarged prostates which encroach Uttle upon the rectum andperineum, but project far into the interior of the bladder, are moreeasily attacked from above by the average operator, so that for thosecases I advocate the suprapubic operation except for the expert. Itcan be done readily, satisfactorily, and effectively, and the results arealmost always good. On the other hand, those prostates which encroachupon the rectum and lie almost entirely in front of the bladder are prop-erly and easily to be removed by the perineal route. The statisticsof both operations vary, and the weight of evidence seems to show thatthe suprapubic operation is somewhat the more dangerous, having a. Fi„ 252.—Diaerammatic drawing, showng above, a flap of mucous membraneleft by^shelling out a prominent third lobe, and below, a remnant ot the urethralmucous membrane extending back into the cavity frorn which the prostate has beenremoved—either of which would tend to form a valvular closure ot the urethra(Cabot). rather higher operative mortality rate. One questions w^hether thismay not be because surgeons have failed to choose their method judi-ciously, but have employed the suprapubic route for cases which shouldhave been operated upon by the perineal route. Suprapubic prostatectonnj is an easy operation, as a mie. inebladder should be fiUed wdth 4 to 6 ounces of boric-acid solution; thepatient should be placed in a mocUfied Trendelenburg position, and thesurcreon should approach the bladder through a transverse, longitudinalor crescentic incision above the pubes. Then, ha^^ng seized the wallsof the bladder, he should open it by dissecting, when, wit
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectsurgery, bookyear1910
