386 THE ABDOMEN AND PELVIS 



condition may be relieved by circumcision. In this operation 

 the prepuce is drawn forwards over the apex of glans and 

 removed. When adhesions are present the prepuce itself 

 cannot be drawn forwards,, and the skin which is drawn forwards 

 is derived from the body of the penis. If this portion is cut 

 away, the cut proximal end at once retracts, and the penis may 

 be almost completely denuded, while the prepuce is left intact, 

 i.e. a circular strip of skin is removed from the body of the 

 penis. 



In the normal case, when the prepuce is cut away, the 

 external covering of skin retracts, but the deep layer remains in 

 contact with the glans. This layer may be slit along the dorsal 

 surface with scissors, but care must be taken not to insert the 

 point of the lower blade into the external urethral orifice. 

 Thereafter, each portion of the deep layer of the prepuce may 

 be stripped from the glans with the ringers, and a layer of smegma 

 is usually disclosed around the corona. 



On the dorsal surface tributaries of the dorsal vein and 

 branches of the dorsal arteries of the penis will require to be 

 tied. In addition, if the frenulum is divided, the little artery 

 which runs in it must be secured ; it is a branch of one of the 

 arteries to the bulb. The cut edge of the skin is then stitched 

 to the deep layer of the prepuce. 



The condition of Paraphimosis results when a tight prepuce 

 is drawn backwards off the glans and allowed to remain as a 

 constricting band above the corona. The glans becomes 

 engorged and cedematous, and actual gangrene may ensue, 

 unless the prepuce is replaced. This may be carried out by 

 exercising steady pressure on the glans with the thumbs while 

 traction on the prepuce is maintained by the encircling fingers. 



The Superficial Dorsal Vein of the Penis arises on the 

 dorsum just behind the glans by the union of small tributaries 

 from the glans and prepuce. It runs backwards in the middle 

 line immediately under the skin of the dorsum, and ends by 

 dividing into right and left branches, which join the internal 

 pudendal veins. 



The Deep Dorsal Vein of the Penis lies on a deeper plane. 

 It passes into the pelvis between the symphysis pubis and the 

 upper edge of the urogenital diaphragm (Fig. 115), and finally 

 it divides into right and left branches, which join the pudendal 

 (prostatic) plexus of veins. 



Each Dorsal Artery of the Penis arises from the internal 



