. Studies on hypertrophy and cancer of the prostate. Fig. 13.—Showing bifid retractor, exposing and making tension on thecentral tendon. Uretlirotomy and insertion of tractor.—After the membranousurethra has been exposed by division of the recto-urethralis musclea retractor is inserted and the apex of the prostate brought into view,as shown in Fig. 14. The membranous urethra is then opened on asound (which was inserted in the urethra before the patientwas put in the lithotomy position), and the edges of the urethralwound caught up by silk sutures or preferably by Halsted clamps. A 20 Hugli H.
. Studies on hypertrophy and cancer of the prostate. Fig. 13.—Showing bifid retractor, exposing and making tension on thecentral tendon. Uretlirotomy and insertion of tractor.—After the membranousurethra has been exposed by division of the recto-urethralis musclea retractor is inserted and the apex of the prostate brought into view,as shown in Fig. 14. The membranous urethra is then opened on asound (which was inserted in the urethra before the patientwas put in the lithotomy position), and the edges of the urethralwound caught up by silk sutures or preferably by Halsted clamps. A 20 Hugli H. Young. sound of moderate size is then passed through the incision into theprostatic urethra and bladder, and the sphincters dilated by a to-and-fro motion of this instrument. The prostatic tractor, closed (Fig. 2),is then passed into the bladder, the edges of the urethral wound beingheld open by the silk sutures to facilitate its introduction. As soon as the beak is free in the vesical cavity the thumb-screw. Fig. 14.—Opening of urethra on sound, preparatory to introduction oftractor. which fixes the blades in position is loosened, the blades rotated 180degrees by means of the external blades, and then fixed by tighteningthe thumb-screw (Fig. 3). ^ Carelessness in this part of the operation may lead to considerabletrouble. If the membranous urethra is not carefully exposed and thor-oughly opened, difficulty may be experienced in picking up the edgesof the mucosa of the urethra on each side. If the edges of the mucosaare not carefully secured with clamps and held apart, they may be invertedby the introduction of the tractor and the operation delayed until theycan be picked up again. study of 145 Cases of Perineal Prostatectomy. 21 The instrument is now ready for whatever traction may be neces-sary to draw the prostate well down into the perineal wound, as shownin Fig. 15. Fig. 16 shows the position of the blades in the interior
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectfistula, bookyear1906
