A Short Treatise on the Section of the Prostate Gland in Lithotomy / With an Explanation of a Safe and Easy Method of Conducting the Operation on the Principles of Cheselden

by C. Aston Key

g. Base of the bladder sinking considerably below the level of the prostate.

The relative bearing of the parts marked e, f, g, may be noticed, in reference to the introduction of the instrument, as delineated in [Plate II].

When the pelvis is bent upon the lumbar vertebræ, and the shoulders of the patient raised, as in the posture for Lithotomy, these parts will have a rather more perpendicular bearing than even is in this view represented.

h. The veins returning the blood from the vena magna ipsius penis injected with wax, entering the pelvis under the pubic arch, through the triangular ligament, in which the vein begins to form a plexus, and concealing the posterior edge of the prostate. In the Celsian operation, this part of the neck of the bladder was cut laterally without dividing the prostate, whence may be inferred the cause of its fatality. In the Gorget operation, if the wound in the prostate is too small for the calculus to pass, this part of the bladder is torn.

i. Triangular ligament, section of. This ligament connects the membranous part of the urethra and prostate gland with the arch of the pubes, protects the dorsal nerve, artery, and veins, in their course to the dorsum penis, and serves the purpose of a barrier between the perineum and the reticular texture surrounding the bladder; it sends a process on each side of the prostate gland, to cover the vesiculæ seminales. The escape of urine after Lithotomy can only be productive of mischief, by infiltrating the cells of the scrotum, or by making its way upwards by the side of the bladder behind this ligament, when the prostate has been torn from its connexions.

k. Rectus abdominis, section of.

l. Peritoneum reflected over the fundus and back part of the bladder, and continued over the rectum.

m. Rectum partly distended by the introduction of a portion of inflated ileum.

n. Accelerator urinæ reflected from the bulb, and discovering the granular lobes of Cowpers’ gland between the bulb and membranous urethra.

o. Muscle of the membranous part of the urethra reflected; not forming a loop around the canal, but (as I have noticed in many subjects), descending from the pubes, and attached to the dense ligamento cellular structure which bounds the edge of the accelerator urinæ; it is continuous with the levator ani.