1046 SURGICAL ANATOMY OF THE PERINEUM. 



of the accelerator urinse, and the transversus periueei with the transverse 

 artery. Then the deep periueal fascia with the muscular fibres between 

 its Ia3 r ers, the membranous part of the urethra, the prostatic part of 

 the canal, and, to a small extent, the prostate itself are successively 

 incised. 



The Blood-vessels : their relation to the incisions. The transverse artery of 

 the perinae.uiu with, it may be, the superficial artery of the perinaeum, is the 

 only aitery necessarily cut through when the vessels have their accustomed 

 arrangement ; for in such circumstances the artery of the bulb is not endan- 

 gered if the knife be passed into the staff iu a direction obliquely upwards, 

 the artery being anterior to the groove of that instrument ; neither is 

 there a risk of wounding the pudic artery} unless the incisions 

 through the deep parts (the prostate for instance) should be carried too 

 far outwards.* 



But in some cases the arteries undergo certain deviations from their 

 accustomed arrangement, whereby they are rendered liable to be wounded in 

 the operation. Thus, the artery of the bulb when it arises, as occasionally 

 happens, from the pudic near the tuber ischii, crosses the line of incision 

 made in the operation, f The arterial branches ramifying on the prostate are 

 in some instances enlarged, and become a source of haemorrhage^ and the 

 veins, too, on the surface of that gland, when augmented in size, may give 

 rise to troublesome bleeding. Lastly, it should be added that the occa- 

 sional artery (accessory pudic), which takes the place of the pudic when 

 defective, inasmuch as it lies on the posterior edge of the prostate, might 

 be divided if the gland were cut through to its base, and only in this 

 event. || 



* For reference to some cases in which the pudic artery was divided in lithotomy, see 

 Crosse's " Treatise on Urinary Calculus," p. 21. London, 1835. 



f "The Anatomy of the Arteries," &c., hy R. Quaiu, p. 442, and plate 64f, figs. 1 

 and 2. A case in which death resulted from divisioa of the artery of the bulb is recorded 

 by Dr Kerr, in the " Kdinb. Med. and Surg. Journal," July, 1847, p. 155. 



J See an essay, entitled "Remarks on the Sources of Hsemonhage after Lithotomy," by 

 James Spence, in the "Edinburgh Monthly Journal of Medical Science," vol. i. p. 166 ; 

 1841. Aud "The Arteries," &c., l.y R. Quain, p. 445. 



"The Arteries," &c., by R. Quain, p. 446, and plate 65, fig. 3. 



II Ibid. p. 444, and plate 63. An instance in which fatal consequences resulted from 

 the division of such an artery has been placed on record. See "Case of Lithotomy 

 attended with Haemorrhage," by J. Shaw, in " The London Medical and Physical 

 Jouriwl," vol. Iv. p. 3, with a figure. 1826. 



