File:Studies on hypertrophy and cancer of the prostate (1906) (14598161457).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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ractor is then removed by first rotating the blades until theycome together and then withdrawing the instrument. Abundant ves-ical drainage should be provided, as a small tube may easily becomeplugged by blood-clots and give great annoyance afterwards. I now use two catheters of fairly good size. These are fastenedtogether by ligatures and are prepared before the operation, so thatas soon as the tractor is withdrawn they can be inserted through theperineal wound into the urethra and bladder. In order to facilitatetheir introduction it is best to cut obliquely across the end of each 40 Rugh H. Young. catheter and then fasten the cut surfaces together with a single suture,thus making a common point for the two catheters. If this is notdone one of the catheter ends may catch in a fold of mucous membrane.One catheter is immediately connected with a tank of normal saltsolution, and the bladder thoroughly washed clean of blood. After the tubes have been properly adjusted, they are tied by a
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Fig.catgut. 58.—Approximation of levator ani muscles with single suture of heavy silk suture to the skin at the upper angle of the wound. Thelateral prostatic cavities are then firmly packed each with a smallstrip of gauze, but care is taken that the packing is confined to thelateral cavities of the prostate and especially that none may beallowed to press against the rectum. The tube and gauze drainageas thus provided is shown in Fig. 37. Approximation of the levator ani muscles.—Before closing the cu- study of 1J/-5 Cases of Perineal Prostatectomy. 41 taneous woiind one should always examine the rectum. With a glovedfinger inserted through the anus and another in the wound the rectalwall should be carefully examined for lacerations or weaknesses.During this procedure it is well to hold the gauze packing and tubesout of the way by means of anterior retraction (Fig. 38). The rectal wall above the anal sphincter is usually found quitethin even in cases where no injury has been done

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