1982 HUMAN ANATOMY. 



tension of the overfull bladder being sufficient to overcome the resistance offered by 

 the tonic contraction of the sphincter muscle plus that due to the prostatic enlarge- 

 ment. {/) Complete retention of urine, due either to an aggravation of the chronic 

 congestion of the urethro-vesical mucosa or to the completion of an atrophic process 

 which has finally destroyed all power of contraction in the bladder. {g) Re/erred 

 pains, similar to those noted as occurring in acute prostatic swelling {vide supra). 

 (/^) Constitutional disturbance, due to septicaemia or uraemia, or both. 



Operations. — Prostatotomy. — Incision or puncture of the prostate for the evac- 

 uation of an abscess may be made through the rectum or by a median perineal 

 incision. The same name is applied to an operation which consists in opening the 

 urethra at the apex of the prostate by a median perineal incision, and dividing the 

 obstructing portion of the gland by means of a probe-pointed bistoury, cutting from 

 within outward. The channel may be further enlarged by divulsion with the finger. 

 The anatomy and relations of the parts involved have already been described (page 

 1921). 



Of the various operative procedures to which the prostate is subjected, prostatec- 

 tomy is, however, by far the most important. Under this name operations have been 

 described which consist of the removal of the enlarged median lobe, or of portions of 

 one or both lateral lobes, or of the whole prostate, by either perineal or suprapubic 

 routes. 



In suprapubic prostatectomy the prostate is approached by means of a supra- 

 pubic cystotomy (page 1921). The mucous membrane over the most prominent 

 portion of the intravesical protuberance is scratched through and, as a rule, the 

 growths or the prostate removed by enucleation with the finger. 



The possibility of total removal of the prostate, and especially of such removal 

 without coincident injury or removal of the prostatic urethra and ejaculatory ducts, 

 has been vigorously discussed. It has been complicated by confusion as to the struc- 

 tures described as the ' ' capsule' ' and as the ' ' sheath. ' ' 



The views of Freyer appear at present to explain most satisfactorily the actual 

 anatomical conditions found at operation, and are thus summarized by him : The 

 prostate is in reality composed of twin organs, which in some of the lower animals 

 remain distinct and separate throughout life, as they exist in the human male during 

 the first four months of foetal existence. After that period, in the human foetus, they 

 approach each other, and their inner aspects become agglutinated, except along the 

 course of the urethra, which they envelop in their embrace. These two glandular 

 organs, which constitute the lateral lobes of the prostate, although welded together, 

 as it were, to form one mass, remain, so far as their secreting substance and functions 

 are concerned, practically as distinct as the testes, their respective gland ducts open- 

 ing into the urethra in the depression on either side of the urethral crest. Each of 

 these two glandular bodies, or prostates, is enveloped by a thin, strong, fibrous 

 capsule ; and it is these capsules — less those portions of them that dip inward, cover- 

 ing the opposing aspects of the glandular bodies or lobes, and thus disappear from 

 view, being embedded in the substance of the prostatic mass — that constitute the 

 true capsule of the prostate regarded as a whole. This capsule extends over the entire 

 organ except along the upper and lower commissures, or bridges of tissue, that unite 

 the lateral lobes above and below the urethra, thus filling in the gaps between them. 

 This true capsule is intimately connected with the prostatic mass and incapable of 

 being removed from it save by dissection. 



The urethra, accompanied by its surrounding structures, — viz., its longitudinal 

 and circular coats of muscles continued forward from the bladder, its vessels and 

 nerves, — passes forward and upward between the inner aspects of the two glands or 

 lobes and is embraced by them. The ejaculatory ducts enter the prostatic mass close 

 together, in an interlobular depression at the lower part of its posterior aspect, each 

 coursing along the inner surface of the corresponding lobe. They do not penetrate 

 the capsules of the lobes, but pass forward in the interlobular tissue, to open into the 

 urethra. 



The prostate, thus constituted and enveloped by its triie capsu/e, is further 

 encased in a second capsule or sheath, formed by the visceral division of the j^elvic 

 fascia, numerous connecting bands passing, however, between the two (Thompson). 



