Operative surgery, for students and practitioners . er the so-called middlelobe, just behind the internal urethral orifice; or an antero-posteriorincision may be made over one or both lateral lobes. The incisionis made with the long, sharp-pointed scissors and extends throughthe entire thickness of the bladder wall down to the proper capsuleof the prostate. The fingers of th^ left hand are introdja^ed intothe bladder to guide the scissors in making the incision. Instead ofthe scissors the sharpened finger-nail may be used to scrape through OPERATIONS UPON THE PROSTATE. 697 tlic wall of the bla
Operative surgery, for students and practitioners . er the so-called middlelobe, just behind the internal urethral orifice; or an antero-posteriorincision may be made over one or both lateral lobes. The incisionis made with the long, sharp-pointed scissors and extends throughthe entire thickness of the bladder wall down to the proper capsuleof the prostate. The fingers of th^ left hand are introdja^ed intothe bladder to guide the scissors in making the incision. Instead ofthe scissors the sharpened finger-nail may be used to scrape through OPERATIONS UPON THE PROSTATE. 697 tlic wall of the bladder. The l)ladder wall over the most prominentl^art ol the prostate mass is usually very tliin, consisting of themucous layer only, and is thus easily penetrated. Through the open-ing which is made the finger is introduced and, working between thewall of the bladder and the prostate, with the finger closely appliedto the capsule of the prostate all the time, the entire hypertrophiedgland enclosed in its proper capsule is enucleated. The gland may. Fig. 312.—Suprapubic Prostatectomy. The waU of the bladder is incised overthe prominent portion of the prostate. Two fingers of the left hand are intro-duced into the rectum to make counterpressure and facilitate the work ofenucleating the prostate. The prostate is enucleated out of its fibrous , peritoneal layer; , sheath of the prostate is continued upward from thebase of the prostate, enclosing the seminal vesicles, etc., and finally thins outand is lost upon the wall of the bladder. The sheath of the prostate forms astrong protecting barrier against injury to the rectum while the prostate isbeing enucleated. , seminal vesicles. be removed in one single mass or in several pieces, two or three. Itcan usually be removed through a single incision. Occasionally itwill be necessary to make an additional incision over a second prom-inent portion of the gland before the entire organ can be the gland is be
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