Surgical Anatomy Part 43

[Ill.u.s.tration]

Plate 61.--Figure 2

Fig. 3, Plate 61.--A cyst, c, is seen to grow from the left side of the base of the prostate, a b, and to form an obstruction at the vesical orifice.

[Ill.u.s.tration]

Plate 61.--Figure 3.

Fig. 4, Plate 61.--A globular excrescence, a, appears blocking up the vesical orifice, and giving to this the appearance of a crescentic slit, corresponding to the shape of the obstructing body. The prostate, b b, is enlarged in both its lateral lobes. A small bougie, c, is placed in the prostatic ca.n.a.l and vesical opening.

[Ill.u.s.tration]

Plate 61.--Figure 4

Fig. 5, Plate 61.--The prostate, d, is considerably enlarged, and the vesical orifice is girt by a prominent ring, b b, from the right border of which the nipple-shaped body, a, projects and occupies the outlet.

Owing to the retention of urine caused by this state of the prostate, the ureters, c c, have become very much dilated.

[Ill.u.s.tration]

Plate 61.--Figure 5.

Fig. 6, Plate 61.--The lateral lobes of the prostate, c c, are seen enlarged, and from the inner side and base of each, irregularly shaped ma.s.ses, a, b, d, project, and bend the prostatic urethra first to the right side, then to the left. The part, a, resting upon the part, b, acts like a valve against the vesical outlet, which would become closed the tighter according to the degree of superinc.u.mbent pressure. A flexible catheter would, in such a case as this, be more likely, perhaps, to follow the sinuous course of the prostatic pa.s.sage than a rigid instrument of metal.

[Ill.u.s.tration]

Plate 61.--Figure 6.

Fig. 7, Plate 61.--A globular ma.s.s, a, of large size, occupies the neck of the bladder, and gives the vesical orifice, c, a crescentic shape, convex towards the right side. The two lobes of the prostate, b, are much enlarged.

[Ill.u.s.tration]

Plate 61.--Figure 7.

Fig. 8, Plate 61.--The lateral lobes, b b, of the prostate are irregularly enlarged, and the urinary pa.s.sage is bent towards the right side, c, from the membranous portion, which is central. Surmounting the vesical orifice, c, is seen the tuberculated ma.s.s, a, which being moveable, can be forced against the vesical orifice and thus produce complete retention of urine. In this case, also, a flexible catheter would be more suitable than a metallic one.

[Ill.u.s.tration]

Plate 61.--Figure 8.

Fig. 9, Plate 61.--The lateral lobes, b b, of the prostate are enlarged.

The third lobe, a, projects at the neck of the bladder, distorting the vesical outlet. A small calculus occupies the prostatic urethra, and being closely impacted in this part of the ca.n.a.l, would arrest the progress of a catheter, and probably lead to the supposition that the instrument grated against a stone in the interior of the bladder, in which case it would be inferred that since the urine did not flow through the catheter no retention existed.

[Ill.u.s.tration]

Plate 61.--Figure 9, 10.

Fig. 10, Plate 61.--Both lateral lobes, b c, of the prostate appear much increased in size. A large irregular shaped ma.s.s, a, grows from the base of the right lobe, and distorts the prostatic ca.n.a.l and vesical orifice.

When the lobes of the prostate increase in size in this direction, the prostatic ca.n.a.l becomes much more elongated than natural, and hence the instrument which is to be pa.s.sed for relieving the existing retention of urine should have a wide and long curve to correspond with the form of this part of the urethra. [Footnote]

[Footnote: Both lobes of the prostate are equally liable to chronic enlargement. Home believed the left lobe to be oftener increased in size than the right. Wilson (on the Male Urinary and Genital Organs) mentions several instances of the enlargement of the right lobe. No reason can be a.s.signed why one lobe should be more p.r.o.ne to hypertrophy than the other, even supposing it to be matter of fact, which it is not. But the observations made by Cruveilhier (Anat. Pathol.), that the lobulated projections of the prostate always take place internally at its vesical aspect, is as true as the manner in which he accounts for the fact is plausible. The dense fibrous envelope of the prostate is sufficient to repress its irregular growth externally.]

Fig. 11, Plate 61.--Both lobes of the prostate are enlarged, and from the base of each a ma.s.s projects prominently around the vesical orifice, a b. The prostatic urethra has been moulded to the shape of the instrument, which was retained in it for a considerable time.

[Ill.u.s.tration]

Plate 61.--Figure 11.

Fig. 12, Plate 61.--The prostate, c b, is enlarged and dilated, like a sac. Across the neck, a, of the bladder the prostate projects in an arched form, and is transfixed by the instrument, d. The prostate may a.s.sume this appearance, as well from instruments having been forced against it, as from an abscess cavity formed in its substance having received, from time to time, a certain amount of the urine, and retained this fluid under the pressure of strong efforts, made to void the bladder while the vesical orifice was closed above.

[Ill.u.s.tration]

Plate 61.--Figure 12.

Fig. 13, Plate 61.--The lateral lobes, d e, of the prostate are enlarged; and, occupying the position of the third lobe, appear as three ma.s.ses, a b c, plicated upon each other, and directed towards the vesical orifice, which they close like valves. The prostatic urethra branches upwards into three ca.n.a.ls, formed by the relative position of the parts, e, c, b, a, d, at the neck of the bladder. The ureters are dilated, in consequence of the regurgitation of the contents of the bladder during the retention which existed ..

[Ill.u.s.tration]

Plate 61.--Figure 13.

Fig. 1, Plate 62, exhibits the lobes of the prostate greatly increased in size. The part, a b, girds irregularly, and obstructs the vesical outlet, while the lateral lobes, c d, encroach upon the s.p.a.ce of the prostatic ca.n.a.l. The walls of the bladder are much thickened.

[Ill.u.s.tration]

Plate 62.--Figure 1.

Fig. 2, Plate 62.--The three lobes, a, d, c, of the prostate are enlarged and of equal size, moulded against each other in such a way that the prostatic ca.n.a.l and vesical orifice appear as mere clefts between them. The three lobes are encrusted on their vesical surfaces with a thick calcareous deposit. The surface of the third lobe, a, which has been half denuded of the calcareous crust, b, in order to show its real character, appeared at first to be a stone impacted in the neck of the bladder, and of such a nature it certainly would seem to the touch, on striking it with the point of a sound or other instrument.

[Ill.u.s.tration]

Plate 62.--Figure 2, 3.

Fig. 3, Plate 62, represents the prostate with its three lobes enlarged, and the prostatic ca.n.a.l and vesical orifice narrowed. The walls of the bladder are thickened, fasciculated, and sacculated; the two former appearances being caused by a hypertrophy of the vesical fibres, while the latter is in general owing to a protrusion of the mucous membrane between the fasciculi.

Fig. 4, Plate 62.--The prostate presents four lobes, a, b, c, d, each being of large size, and projecting far into the interior of the bladder, from around the vesical orifice which they obstruct. The bladder is thickened, and the prostatic ca.n.a.l is elongated. The urethra and the lobes of the prostate have been perforated by instruments, pa.s.sed for the retention of urine which existed. A stricturing band, e, is seen to cross the membranous part of the ca.n.a.l.

[Ill.u.s.tration]