. Surgery, its principles and practice . rted through aurethrotomy woundof the membranousurethra and the pos-terior surface of theprostate has beenexposed, largely byblunt dissection. Ifthere is then anydoubt in the mindof the operator as to the malignant nature of the disease, an incision is made through thecapsule and a section of the prostatic lobe removed for examination,frozen sections being made if necessary to establish the diagnosis, wheneither the simple prostatectomy operation for hypertrophy or the radicaloperation for cancer can be performed as the case requires. In the caseof canc
. Surgery, its principles and practice . rted through aurethrotomy woundof the membranousurethra and the pos-terior surface of theprostate has beenexposed, largely byblunt dissection. Ifthere is then anydoubt in the mindof the operator as to the malignant nature of the disease, an incision is made through thecapsule and a section of the prostatic lobe removed for examination,frozen sections being made if necessary to establish the diagnosis, wheneither the simple prostatectomy operation for hypertrophy or the radicaloperation for cancer can be performed as the case requires. In the caseof cancer the next step after exposing the posterior surface of the prostateis to free the lateral adhesions of the prostate and also the seminal vesiclesas much as possible by blunt dissection; then the membranous urethrais divided in front of the tractor, as shown in Fig. 241. The handle ofthe tractor is then depressed markedly and the puboprostatic ligamentsdivided with scissors close up to the anterior surface of the prostate, VOL. IV—30. Fig. 241.—After Transverse Section of Urethra. 466 SURGERY OF THE PROSTATE. efforts being previously made to push away the anterior plexus of veinsby blunt dissection. Fairly abundant hemorrhage usually follows, andshould be controlled as much as possible by clamps and then by a gauzepack, which should be held tightly against the posterior surface of thepubes and the triangular ligament by means of a retractor. The prostate is then drawn outward as far as possible, thus exposingthe anterior surface of the bladder, which should be punctured, as shownin Fig. 242, just above the prostato-vesical juncture. This wound is nowenlarged on each side by scissors, the line of division being close to theprostato-vesical juncture, until the trigone is exposed, as shown in With a scalpel a curved incision is made across the trigone, thus leaving the upper/ \ j^^ ^ angles of the tri- ** gone intact and being careful to dono injury to theureters. By
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