File:The surgical diseases of the genito-urinary organs including syphilis (1889) (14594619840).jpg

Identifier: surgicaldiseases00keye (find matches)
Title: The surgical diseases of the genito-urinary organs including syphilis
Year: 1889 (1880s)
Authors: Keyes, E. L. (Edward Lawrence), 1843-1924
Subjects: Urology Syphilis
Publisher: New York : D. Appleton and Company
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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ostatic ure-thra, the course of the latter becomes by so much the more devious.When one lateral lobe is hypertrophied alone, or to a greater degree * On the Anatomy and Diseases of the Urinary and Sexual Organs, 1S36. 176 DISEASES OF THE PROSTATE. than its fellow, the urethra is pushed toward tlie opposite side. Whenthere is posterior median hypertrophy (as occurs in the majority ofcases applying for treatment), we have the gieatest degree of oblitera-tion of the canal for the least amount of overorowth. Most cases ofprostatic hypertropliy probahly never come under the surgeons notice,in consequence of there being no obstruction to the outllow of urine.Many an old man goes to his grave with enlarged prostate, the exist-ence of which has never been suspected. Of those cases which areseen, median hypertrophy exists in a large proportion. This mediancentral part of the prostate lies at the neck of the bladder directly inthe vesical orifice of the urethra (Fig. 56). As it grows upward and
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Fig. 56. backward, it fill.> the mouth of the bladder, and converts its naturallyrounded orifice into a crescentic slit, convexity ujjward. The floor ofthe prostatic urethra is also unnaturally tilted up, to override thisbulkhead which has sprung up in its course. Fig. 57 shows the effectupon the course of the urethra of this so-called third lobe, and sug-gests at once the two great facts which are the key-notes to a correctunderstanding of the pathology of hypcrtrophicd prostate, and of tliemeans of relieving its most prominent symptom—retention. Thesefacts are— 1. That such a growtli occupying the vesical orifice, and juttingout behind and above it, must ob-truct the free outflow of the urinefrom the bladder. 2. That an instrument of ordinarv curve, introduced from witliout, HYPERTROniY. 177

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