The surgical anatomy of the operation of suprapubic prostatectomy / by J.W. Thomson Walker.

  • Thomson-Walker, J. W. (John William), 1871-1937.
Date:
1905
Catalogue details

Licence: In copyright

Credit: The surgical anatomy of the operation of suprapubic prostatectomy / by J.W. Thomson Walker. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    urethra between the prostatic lobes. In the normal prostate, at the level of the verumontanum, the urethra is situated about midway between the anterior and posterior surfaces. In a similar section of an enlarged prostate it is found that the pos- terior wall of the urethra has passed backwards between the lobes, and now occupies a position at the posterior surface with little or no gland tissue behind it. This change is greatest at the level of the verumontanum. If an enlarged prostate be cut antero-posteriorly so that the urethra is split open along its anterior and posterior walls, the anterior wall will be found to be almost straight. The posterior wall, however, passes from the vesical outlet downwards and backwards to the level of the verumontanum, and from this almost directly forwards. A deep pocket is thus formed in the posterior wall with its apex at the verumontanum. The structure which appears to me to play the most important part in causing this change is the fibrous and muscular band which surrounds the ejaculatory ducts. This band finds attachment at the verumontanum at one end and at the seminal vesicles at the other. It has already been noted that the seminal vesicles are stripped from the bladder wall and forced backwards by the enlarging lobes. This must exercise a continuous backward drag on the posterior wall of the urethra and tend to tear it from between the prostatic lobes. III.—THE STRUCTURES REMOVED AT THE OPERATION OF PROSTATECTOMY. In examining the series of prostates removed by enucleation they were found to vary in three important particulars. The weight of the smallest was but three-quarters of an ounce, while the largest weighed 10j ounces. Size did not, however, form a convenient basis for classification for the purpose of the present investigation ; for although, as a general rule, the larger growths are more easily enucleated than the smaller, yet there are considerable variations in the ease with which the operation is carried out, which are dependent upon other factors than the size of the enlarged organ. In some of the specimens the two lobes were bound together by a continuous capsule, while in others the capsule was rup- tured along the anterior surface, so that the lobes could be