1398 



THE URINOGENITAL ORGANS 



researches, conducted at Greenwich Hospital, it would seem that such obstruction exists in 20 

 per cent, of all men over sixty years of age. The prostate may be enlarged by the growth of 

 innocent tumors, adenomata, fibromata, myomata, and myofibromata. The entire gland may 

 be hypcrtrophied. A tumor may be encapsulated, but often is surrounded by an area of hyper- 

 plasia of prostatic tissues, and usually the area of hyperplasia is much more extensive than the 

 tumor. A tumor may be beneath the mucous membrane, deep in the gland, or beneath the 

 sheath. The growth called the third lobe is submucous. In some cases the enlargement affects 

 principally the lateral lobes, which may undergo considerable enlargement without causing much 

 inconvenience. In other cases it would seem that the nodule forms the so-called middle lobe, 

 and even a small enlargement of this character may act injuriously, by forming a sort of valve 

 over the urethral orifice, preventing the passage of the urine, and the more the patient strains, 

 the more completely will it block the opening into the urethra. In consequence of the enlarge- 

 ment of the prostate a pouch is formed at the base of the bladder behind the projection, in which 

 urine collects and cannot be entirely expelled. The urine becomes decomposed and ammoniacal, 

 and leads to cystitis. If the prostate enlarges the urethra is lengthened, often dilated, altered in 

 shape, or distorted. 



The relation of the enlarged prostate to the neck of the bladder is greatly altered from the 

 relation of the normal prostate. Normally, it is extravesical ; when enlarged it may encapsule 

 "the neck of the bladder in a cuff-like manner, extending several inches upward on its wall," 

 and often it protrudes "into the vesical cavity, carrying on its surface the mucosa vesicae." In 

 many cases of prostatic enlargement the gland should be removed (prostatectomy). One method 

 is enucleation through a suprapubic incision; another method is enucleation through a perineal 

 incision; another method is carried out by both incisions (the combined method). 



In elderly individuals the gland tubules may form round, indurated, and sometimes calcified 

 masses, about 1 mm. in diameter, and called prostatic stones. 



MOUTH OF EJACU- 



LATORY DUCT 

 VERUMONTANUM 



PROSTATE CUT SURFACE 

 OPENINGS OF 

 PROSTATIC DUCTS 



DUCT OF COWPER'S 

 GLAND LAID BARE 



[ CORPUS SPON- 



G1OSUM CUT SURFACE 



FIG. 1154. Proximal portion of the urethra, laid open by a median, anterior cut. (Xestut.) 



COWPER'S GLANDS fGLANDULAE BULBOURETHRALES) (Fig. 1154). 



Cowper's glands are two small, rounded, and somewhat lobulated bodies of 

 a yellow color, about the size of peas, placed behind the fore part of the mem- 

 branous portion of the urethra, between the two layers of the triangular ligament. 



