Anatomy, Surgical and topographical -- Atlases; Surgery -- Atlases; Surgery, Operative -- Atlases
The prostate being a median structure, is formed of two lobes, united at
the median line. The bulbus urethrae being also a median structure, is
occasionally found notched in the centre, and presenting a bifid
appearance. On the base of the bladder, P, Fig. 2, Plate 53, the two
vasa deferentia, Q Q, are seen to converge from behind forwards, and
enter the base of the gland; a triangular interval is thus formed
between the vasa, narrower before than behind, and at the middle of this
place the point of the trocar is to be passed (through the rectum,) for
the purpose of evacuating the contents of the bladder, when other
measures fail. When this operation is required to be performed, the
situation of the prostate is first to be ascertained through the bowel;
and at a distance of an inch behind the posterior border of the gland,
precisely in the median line, the distended base of the bladder may be
safely punctured. If the trocar pierce the bladder at this point, the
seminal vessels converging to the prostate from either side, and the
recto-vesical serous pouch behind, will escape being wounded. If the
prostate happen to be much enlarged, the relative position of the
neighbouring parts will be found disturbed, and in such case the bladder
can be punctured above the pubes with greater ease and safety. In cases
of impassable stricture, when extravasation of urine is threatened, or
has already occurred, the urethra should be opened in the perinaeum
behind the place where the stricture is situated, and this (in the
present instance) certainly seems to be the more effectual measure, for
at the same time that the stricture is divided, the contents of the
bladder may be evacuated through the perinaeum. If the membranous part
of the urethra be that where the stricture exists, a staff with a
central groove is to be passed as far as the strictured part, and having
ascertained the position of the instrument by the finger in the bowel,
the perinaeum should be incised, at the middle line, between the bulb of
the urethra and the anus. The urethra in this situation will be found to
curve backwards at the depth of an inch or more from the surface. The
point of the staff is now to be felt for, and the urethra is to be
incised upon it. The bistoury is next to be carried backwards through
the stricture till it enters that part of the urethra (usually dilated
in such cases) which intervenes between the seat of obstruction and the
neck of the bladder.
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