570 ABDOMEN 



fascia of the uro-genital diaphragm and turned downwards until the urethra 

 is brought into view. It pierces the upper part of the fascia in the medial 

 plane and passes at once into the bulb. 



The muscles and fascia must now be detached from the anterior surfaces 

 and upper borders of the bodies of the pubic bones, and from the upper 

 parts of the pubic rami. Then the bones must be cut through, with the 

 saw, on each side, along a line running from below the attachment of the 

 arcuate ligament to the lateral side of the pubic tubercle (see Fig. 222). 

 By these saw-cuts a considerable part of the anterior wall of the pelvis is 

 isolated, and it can be removed when the vesical layer of the endo-pelvic fascia 

 has been detached from its posterior surface. Having been removed, it must 

 be kept for the examination of the inter-pubic joint. Whilst the bone 

 is being removed care must be taken to avoid injuring the dorsal vein 

 of the penis. After the bone is removed the dissector will see the anterior 

 border of the vesical layer of the endo-pelvic fascia which has been detached 

 from the back of the pubis. In this fascia he will readily recognise the 

 thickened bands of the pubo-prostatic ligaments. The vesical layer must 

 now be divided in the medial plane and turned laterally to each side. 

 Whilst this is being done it will be noticed that above the prostate the 

 vesical layer is gradually lost on the anterior border and infero-lateral 

 surfaces of the bladder (Fig. 223). When the fascia has been turned 

 laterally to its junction with the recto-vesical layer, already displayed from 

 below, the dorsal vein of the penis must be followed backwards. It 

 divides, immediately after entering the pelvis, beneath the vesical layer 

 of fascia, into right and left branches which join the corresponding parts of 

 the pudendal (O.T. prostatic] venous plexus. 



The dissector should notice that, by the removal of the 

 bone in the region of the symphysis, he has exposed not only 

 the structures already noted, but also the whole of the anterior 

 border of the bladder and parts of its infero-lateral surfaces. 

 If he now replaces the pelvic peritoneum, he will find that it 

 has no relation to the border and surfaces mentioned ; they lie 

 entirely below the level of the peritoneum. They form the 

 posterior boundary of the lower part of the cave of Retzius, 

 and lie in relation with the anterior and antero-lateral parts 

 of the pelvic wall, from which they are separated by the 

 extra-peritoneal fatty tissue which was removed at an earlier 

 stage of the dissection. The dissector has now seen three 

 surfaces of the bladder, the superior surface covered by peri- 

 toneum, and the two infero-lateral surfaces. The bladder 

 possesses also a fourth surface, the fundus or base, which lies 

 in relation with the ductus deferentes, the seminal vesicles, and 

 to a less extent with the lower part of the anterior wall of the 

 rectum. This surface and the interior of the bladder should 

 now be investigated. 



Dissection. Enter the knife through the anterior border of the bladder, 

 a little below its upper extremity, and carry it backwards first on one side 

 and then on the other, just below the upper border of each infero-lateral 



