File:Clinical lectures on the surgical diseases of the urinary organs (1908) (14757860446).jpg

Identifier: clinicallectures1908frey (find matches)
Title: Clinical lectures on the surgical diseases of the urinary organs
Year: 1908 (1900s)
Authors: Freyer, P. J. (Peter Johnston), Sir, 1851-1921
Subjects: Genitourinary organs Urogenital System Urogenital System Urethra
Publisher: New York : William Wood & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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Ste&tk — Capsule.-- Plane of Separation J.W.TW. tjatoUtory Ducts Fig. 47.—Diagrammatic View of Coronal Section of Prostateand Surrounding Sheath. described that is removed, the outer capsule or sheath beingleft behind, thus preventing infiltration of urine into thecellular tissues of the pelvis. The text-books, as a rule,drew no distinction between the two separate coverings ofthe prostate, treating them both combined, or the outer oneonly, as the capsule. To persons brought up in this schoolof thought and teaching my operation must at first sightnecessarily have appeared impossible. In most, if not in all, cases of enlargement of the prostate ii2 OPERATIOX OF TOTAL ENUCLEATION OF PROSTATE of declining life (cancer being excluded) the overgrowth isadenomatous in character, numerous encapsuled adenomatous tumours being found embedded within the substance of thelobes, and frequently protruding on their surfaces. Theysometimes assume the form of polypoid outgrowths (Fi(
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^w i-otx. . nqvUr L.. . J.WTa . ii w oi Horizon i \l Si ctioi ENLARi i D PR( IS! \i I VND Bl U)D1 R. which, however, are invariably enclosed within the U ue capsule,whit 1 hi d before them. the lobes enlarge they bulge out and have a tendency, each enclosed within it i >wn i apsule, to 1>seh attached alone their OPERATION OF TOTAL ENUCLEATION OF PROSTATE 115 commissures (particularly the anterior one), which in thenormal prostate unite them in front of, and behind, theurethra. And in the course of this change the urethra, withits accompanying structures, is loosened from its close attach-ment to the inner surfaces of the lobes, particularly in frontof the verumontanum, thus facilitating its being detached andleft behind in the removal of the prostate, as will presentlyappear. In the earlier stages of the adenomatous overgrowth theenlargement is probably entirely extraves

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