414 



The Prostate 



The prostatic plexus of veins empties on either side into the internal 

 iliac vein. 



The arteries of the prostate come from the internal iliac, inferior 

 vesical, internal pudic, and inferior haemorrhoidal. An irregular in- 

 ternal pudic artery may run by the side of the prostate (p. 442). The 

 nerves are derived from the hypogastric plexus. The lymphatics enter 

 the chain of glands along the internal iliac artery. 



Middle lobe. At the upper and back part of the prostate, between 

 the lateral lobes, may be found a small, rounded lobe, ' intimately con- 

 nected with the other two, and fitting in between them and the bladder 

 and the adjacent part of the urethra. When prominent it corresponds 

 to the elevation in the urinary bladder, called the uvula ' (Quain). A 

 slight enlargement of the ' middle lobe ' upwards may cause serious 

 obstruction at the neck of the bladder, and will give increased length 

 to the urethra ; nevertheless, if the rest of the prostate be not hyper- 

 trophied, a digital exploration by the rectum may give no information 

 of the condition, the growth being into the bladder rather than towards 

 the rectum. In most cases, however, hypertrophy of the prostatic 



tissue is general, and 

 can readily be esti- 

 mated per anum. If 

 the enlargement be 

 extreme, the bladder 

 is pushed upwards 

 and forwards, the 

 neck being increased 

 in length. To draw 

 off the retained urine, 

 a long catheter with 

 a sudden curve is 

 needed. In enlarge- 

 ment of the middle 

 lobe, a soft, elbowed 



(coud^ catheter 



answers well, the beak 

 readily surmounting the obstruction. Enlargement of the prostate 



Hypertrophy of median and of lateral lobes of prostate; bladder 

 dilated and thickened ; ' prostatic ' catheter. 



obstructs micturition, and necessitates the subject of it learning the art 

 of drawing off the residual urine by a catheter. Sometimes the patient 

 stimulates the bladder to contract by sitting upon a cold seat. Some- 



