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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    The prostatic ring- might, however, be slipped off the urethra if the tube were torn across at one part. This is reported to have happened in one case. Secondly, the whole urethra may be left behind. In these cases the prostate is almost invariably of the open variety. The muscular wall of the urethra is also left behind in these cases, not merely the tube of mucous membrane. What the condition of the urethra which is wholly left behind at the operation may be, I have only the evidence of one post-mortem examination to shew. In this specimen the urethra was torn across at the level of the verumontanum, and the upper and lower segments were left projecting into the cavity. What the ultimate fate of the prostatic urethra which is left behind after prostatectomy may be, is at the present time a matter for speculation. My impression is that when a living tube of this length is isolated and remains merely attached at each end the lack of blood supply will lead to sloughing, at all events of the central part. It might, of course, be com- pared with the extensive stripping of the ureter from its connections, or even to the isolation of a portion of an artery, both of which may be carried out without any permanent harm resulting. The cases are not, however, exactly parallel, for each of these tubes carries its own blood-supply, which the isolation of even a considerable segment does not materially damage, and, moreover, the urethra in prostatectomy has been subjected to considerable violence during the operation. It might be held that the walls of the cavity close around the urethra and the nutrition of the tube is maintained by a collateral circulation through adhesions. An exumunition of the fascial lining of the cavity does not, however, support the idea that rapid adhesion will take place, and the manipulations during the operation, added to the septicity which is seldom absent from such bladders, are more than likely to forestall any adhesion by causing the death of the tube. There is a third condition shewn by these specimens. Part of the tube may be removed and part left behind. If one of the open variety of prostates be examined it may be found that the fiat inner surface of each lobe for a considerable area is smooth and glistening, and that the lobes are united by a hinge of tissue which binds them together at the upper half of their