ENLAEGEMENT OF THE PROSTATE. 445 



but more firmly behind that channel, the urethra itself traversing 

 the organ. Hence it follows that any increase in size of the 

 prostate must necessarily lead to alterations in the direction and 

 size of the urethra. 



But while this is true, it is the projection of the enlarged 

 prostate into the vesical cavity which, as a rule, causes most 

 inconvenience, and the subsequent serious results. In enlarging, 

 the tissue increases in the line of least resistance, and not infre- 

 quently this is towards the interior of the bladder. Hence there 

 projects upwards a so-called middle lobe which is in reality an 

 asymmetrical outgrowth of a lateral lobe. This tends to block 

 the exit from the bladder, and particularly so when the patient 

 strains during the act of micturition. It may very easily lead 

 to complete retention of urine, necessitating speedy relief. 



The passage of a catheter along the urethra into the bladder 

 may be rendered difficult by the point of the instrument im- 

 pinging against this projecting mass from a lateral lobe. Hence 

 it is advantageous to use a coude or elbowed catheter, so that it 

 may mount up over the elevation and pass more readily into the 

 bladder beyond. 



Kemoval of an enlarged prostate, either by the suprapubic or 

 perineal route, is in many cases probably the enucleation of 

 adenomata which have compressed the prostatic tissue itself into a 

 very thin layer. It is, however, theoretically possible by inserting 

 the finger between the prostatic sheath proper and the visceral 

 layer of the pelvic, recto-vesical, fascia, to enucleate the whole of 

 the gland, but in such cases there is a great tendency for con- 

 siderable haemorrhage, on account of the damage done to the 

 plexus of veins lying between the two layers of fascia. In either 

 case the contained urethra is usually torn away. 



FEMALE. 



THE OVARY. 



Ovarian Cysts. The ovary is placed in the peritoneum 

 forming the postero-internal layer of the fold constituting the 



