File:A manual of operative surgery (1910) (14760264141).jpg

Identifier: manualofoperativ0001trev (find matches)
Title: A manual of operative surgery
Year: 1910 (1910s)
Authors: Treves, Frederick, Sir, 1853-1923 Hutchinson, Jonathan, 1859-1933
Subjects: Surgical Procedures, Operative Surgery
Publisher: Philadelphia : Lea & Febiger
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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a new form of operation. The whole sub-ject is ably discussed and summarised in two interesting papers by Mr.Southam and Sir William Thomson (Brit. Med. Journ., April 18th,I903)- Anatomical and other Considerations.—As seen in Fig.176, the prostate is composed of two lateral lobes, separatedonly in part by the urethral canal. The so-called middle lobewould appear to be in most, if not all, cases a projection up-wards behind the vesical orifice from one or other lateral lobe ; 654 ABDOMINAL OPERATIONS (PART II it is always a pathological product. The apex of the prostaterests on the triangular ligament ; the base or upper end is closelyconnected with the sphincter of the bladder. The prostate is encased in a fibrous capsule which sendsin processes amongst the glandular masses of which the organ islargely composed. These septa of fibrous tissue are reinforced bymuch unstriped muscular tissue and by blood-vessels. How muchof the normal prostate is glandular will be seen from Fig. 177.
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FIG. 176.—SECTION THROUGH THE PROSTATIC URETHRA TO SHOW THE RELATIONS OFTHE PROSTATE GLAND (p) TO ITS FASCIAL INVESTMENT, ETC. (After Testut.) i, Levator ani, enclosed between two layers of fascia, the inner one forming the true sheathof the prostate ; 2, Ischio-rectal fossa. The capsule which closely adheres to the prostateis shown as a thin line, outside which are many veins cut across. Immediately outside this fibrous sheath of the prostate is aplexus of veins and then the recto-vesical sheath of fascia, whichforms an outer investment of the prostate and separates it fromthe levator ani, the rectum, and the os pubis. It is importantto note that when removal of the entire prostate in its capsuleis spoken of, the inner true capsule is meant, and not the recto-vesical layer, which is prolonged upwards (encasing the vesiculasseminales) on to the rectum and bladder. The venous plexusalluded to is particularly well developed in front of the prostate(Fig. 177), between it and the os pub

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