File:Studies on hypertrophy and cancer of the prostate (1906) (14597988300).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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ostatic capsule by blunt dissection until theentire posterior surface of the prostate was brought into view.Up to this point the operator proceeded exactly as in the usual prostat-ectomy operation. The tissues around the prostate were more hemorrhagicand the wall of the rectum more closely adherent to the capsule of the pros-tate than usual. Examination of the prostate then showed much greaterinduration than I had ever encountered in a benign prostate. The rectumVol. XIV.—32. 500 Hugh H. Young. and the periprostatic tissues were free from invasion. Complete excisionwas therefore decided upon, and carried out as follows: The handle of thetractor was depressed, thus exposing the membranous urethra anterior toit, where it was easily divided transversely with a scalpel, leaving a smallstump of the membranous urethra protruding from the posterior surfaceof the triangular ligament. By further depressing the handle of thetractor the puboprostatic ligament was exposed, and being very tautly
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Fig. 2.—Exposure of the seminal vesicles. drawn, easily divided by scissors, thus completely severing the prostatefrom all important attachments (except posteriorly), as shown in Fig. 1.The lateral attachments, which are slight, were easily separated by thefinger. During these manipulations a moderate amount of hemorrhagewas encountered (coming from the periprostatic veins, particularly thosejust behind the triangular ligament in front of the prostate), but it waseasily controlled by clamping several bleeding points, and applying pres-sure with gauze by means of an anterior deep retractor (see Fig. 3). The posterior surface of the seminal vesicles were then freed by bluntdissection, the now mobile prostate being drawn well out of the wound, as An Operation for Cancer of Prostate. 501 shown in Fig. 2. In this exposure of the posterior surface of the vesiclesI was careful not to break through the fascia of Denonvilliers, which coversnot only the posterior surface of the prostate but a

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