1920 



HUMAN ANATOMY. 



the pelvic fascia (which is reflected from the gland near its upper end), favoring the 

 development of pelvic cellulitis from urinary infiltration (page 1933) ; or it might 

 divide the neck of the bladder and open up the recto-vesical fossa with the same 

 results ; or, if the prostatic incision were too extensive and too vertical, it might 

 wound the ejaculatory ducts or seminal vesicles. The incision which is made after 

 a grooved staff has been introduced into the bladder, and while it is held in place by 

 an assistant accordingly begins at a point a little to the left of the raphe and a little 

 posterior to the perineal centre i.e. , about one to one and a quarter inches in front 

 of the anus and, opening the left ischio-rectal fossa, ends at the junction of the 

 outer and middle thirds of a line drawn between the posterior margin of the anus 

 and the ischial tuberosity. This incision should' be deepest near its upper end not 

 far, at its upper and deepest portion, from the apex of the " perineal triangle" and 

 should become shallower as it passes into the ischio-rectal space. It divides skin, 



FIG. 1630. 



Sectional surface of 

 corpus spongiosum 



Corpus cav- * 



ernosum, cut m 



Adductor brevis 



Adductor -~-, 

 magmis 



Ramus of 



isi-hium } 

 Tuber ischii--- 



Obturator 

 internus . 



Levator ani - 



Greater sacro- < 

 sciatic liK-um-Mt 



Coccygeus- 



Gluteus ; 

 maximus, nit 



Corpus cavernosum, 



cut 

 Urethra 



Subpubic ligament 

 Prostate 



-Tuber ischii 



-Obturator 

 internus 



Greater sacro- 

 sciatic ligament 



-Gluteus 

 maximus 



Coccyx 



, 



Deep dissection of perineu 

 emerg' 



n of perineum, in which root of penis has been removed, showing urethra 

 ing from prostate, which is partly exposed between levatores ani. 



both layers of superficial fascia, the superficial transverse perineal muscle, artery, and 

 nerve, the lower edge of the superficial layer of the triangular ligament, and, as it 

 crosses the ischio-rectal fossa, the inferior hcmorrhoidal vessels and nerves. 



The ten forefinger of the operator now guides the knife into the groove of the 



and the incision is deepened with the knife-blade inclined laterally and pushed 



1 into the bladder, dividing the compressor urethra muscle, the membranous 



ira. the superior layer oi the triangular ligament, a few median fibres of the leva- 



prostatic urethra, and a portion of the left lobe of the prostate. 

 The neck of tin- bladder should be dilated with the finger rather than incised, 

 I will, without sen,, us laceration, permit the extraction of a stone of the diameter 

 ot an inch to an inch and a quarter. 



In children the following facts should be borne in mind : () the relative nar- 

 the pelv.s, limiting the operative space ; (J) the undeveloped condition 



