File:Studies on hypertrophy and cancer of the prostate (1906) (14598019888).jpg

Identifier: studiesonhypertr00youn (find matches)
Title: Studies on hypertrophy and cancer of the prostate
Year: 1906 (1900s)
Authors: Young, Hugh H., 1870-1945 Johns Hopkins Hospital
Subjects: Prostatic Hypertrophy Prostatic Neoplasms Fistula
Publisher: Baltimore, Johns Hopkins Press
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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surethra and the apex of the prostate, it is necessary to divide this muscle,as shown in Fig. 13. This at once exposes the espace decollable retro-prostatique which has been so well described by Proust, who has shownthat unless this muscle is divided the operator is apt to tear into therectum, which is drawn forward by it. Division of this muscle allows therectum to drop back, and leads at once into the space surrounding theposterior surface of the prostate. study of 1J/.5 Cases of Perineal Prostatectomy. 19 allows it to partly encircle the urethra and catch the triangular liga-ment. At this stage it is generally best to remove the bifid retractor and to insert a narrow-bladed retractor about two inches in depth, bywhich the rectum can be pushed back and the muscular fibers sur-rounding the membranous urethra—the recto-urethralis—put upontension. They are then divided by a transverse incision close up tothe triangular ligament and the membranous urethra exposed by bluntdissection.
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Fig. 13.—Showing bifid retractor, exposing and making tension on thecentral tendon. Uretlirotomy and insertion of tractor.—After the membranousurethra has been exposed by division of the recto-urethralis musclea retractor is inserted and the apex of the prostate brought into view,as shown in Fig. 14. The membranous urethra is then opened on asound (which was inserted in the urethra before the patientwas put in the lithotomy position), and the edges of the urethralwound caught up by silk sutures or preferably by Halsted clamps. A 20 Hugli H. Young. sound of moderate size is then passed through the incision into theprostatic urethra and bladder, and the sphincters dilated by a to-and-fro motion of this instrument. The prostatic tractor, closed (Fig. 2),is then passed into the bladder, the edges of the urethral wound beingheld open by the silk sutures to facilitate its introduction. As soon as the beak is free in the vesical cavity the thumb-screw

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