THE PROSTATE. 451 



(page 438, recto-urethralis muscle) are then divided and the rectum pushed back 

 (Fig. 455). This exposes the prostate; its outer capsule or sheath is then incised and 

 the growth removed with the finger or forceps. In order to prevent injury to the 

 ejaculatory ducts Young enucleates through two lateral incisions, thus leaving a middle 

 strip in which the ejaculatory ducts are contained. According to Gosset and Prousfc 

 {Manuel de la Prostatectomie , Paris, 1903) the fascia between the prostate and rectum 

 (aponeurosis of Denonvilliers) is composed of two layers, an anterior one on the 

 prostate its sheath and another posterior one on the rectum. When the recto- 

 urethralis muscle is divided the incision should likewise divide the posterior or rectal 

 layer, which is then pushed back with the rectum. Thus is formed the ' ' espace 



Ischiocavernosus 



Bulbocavernosus 

 Central point of 

 perineum 



Superficial transverse 

 perineal muscle 



Membranous urethra 

 Prostate 



Recto-urethralis muscle 

 Levator ani 



Lower end of rectum 

 External sphincter ani 



FIG. 455. The parts involved in prostatectomy. The external sphincter ani has been divided at the central 

 point of the perineum and with the lower portion of the rectum has been drawn back, thus putting the recto-ure- 

 thralis muscle on the stretch and exposing the prostate to each side. 



decollable r6troprostatique ' ' or separable space and the anterior layer or sheath of 

 the prostate is exposed. 



Abscess. Inflammation and abscess of the prostate follow injury and infection 

 from the introduction of catheters or bougies and also from gonorrhoea. The hot and 

 enlarged gland can readily be felt through the rectum. The bladder and rectal 

 symptoms are marked. Pus tends to discharge either into the urethra or rectum, 

 more rarely it may point in the perineum behind the triangular ligament and in front 

 of the anus. Abscesses breaking into the urethra may leave a large cavity, which 

 becomes a receptacle for pus, urine, and calculi, and hastens a fatal issue. When 

 breaking into the rectum intractable fistulse may result. Prostatic abscesses should 

 be opened by an incision in the perineum just anterior to the anus, the finger being 

 introduced into the rectum to avoid wounding it. 



