. Studies on hypertrophy and cancer of the prostate. Fig. 33.—Photograph, natural size. bridge is preserved. This method has been employed in severalcases. In the great majority of cases the median mass can be enucleatedthrough the lateral cavity—the larger the lobe the easier it is. TEEATMEXT OF VESICAL CALCULUS AS A COilPLICATIOX OF EXLARGED PROSTATE. When calculus is present, either litholapaxy, before or during theprostatectomy operation, or suprapubic or perineal lithotomy may beperformed. Without going into arguments for or against either ofthese procedures, it is evident that if a perin
. Studies on hypertrophy and cancer of the prostate. Fig. 33.—Photograph, natural size. bridge is preserved. This method has been employed in severalcases. In the great majority of cases the median mass can be enucleatedthrough the lateral cavity—the larger the lobe the easier it is. TEEATMEXT OF VESICAL CALCULUS AS A COilPLICATIOX OF EXLARGED PROSTATE. When calculus is present, either litholapaxy, before or during theprostatectomy operation, or suprapubic or perineal lithotomy may beperformed. Without going into arguments for or against either ofthese procedures, it is evident that if a perineal prostatectomy is to !6 Hugh E. Young. be performed the ideal procedure is to remove the calculus at thesame sitting, without crushing it, for litholapasy is in these cases atedious procedure. If, however, the removal of the calculus intactwill seriouslj^ injure the urethra, the ejaculatory ducts or the neckof the bladder, such a method is contraindicated. To drag a calculusby main force out through the urethra, as left by the technique. Fig. 34.—Division of lateral wall of urethra to allow extraction of largecalculus through left lateral cavity. which I follow, would be at once dangerous and destructive, exceptwhen it is small. I have therefore endeavored to devise a method which would be freefrom the dangers mentioned above, and which would also provide forthe removal of large stones. The technique which I have found mostsatisfactory is graphically shown in the accompanying drawing(Fig. 34). study of IJfO Cases of ?Perineal Prostatectomy. 37 x\s seen here, tlie urethra is split with scissors along its left lateralwall, from the urethrotomy wound in the membranous urethra up toits vesical orifice. By this procedure, the urethra becomes a commoncavity with that left by the enucleation of the left lateral lobe, andabundant room is furnished for the extraction of calculi. If thecystoscope has shown the calculus to be only moderately large it isusually only necessary to d
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