Part 43 (1/2)

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Plate 61.--Figure 2

Fig. 3, Plate 61.--A cyst, c, is seen to grow from the left side of the base of the prostate, a b, and to form an obstruction at the vesical orifice.

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Plate 61.--Figure 3.

Fig. 4, Plate 61.--A globular excrescence, a, appears blocking up the vesical orifice, and giving to this the appearance of a crescentic slit, corresponding to the shape of the obstructing body. The prostate, b b, is enlarged in both its lateral lobes. A small bougie, c, is placed in the prostatic ca.n.a.l and vesical opening.

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Plate 61.--Figure 4

Fig. 5, Plate 61.--The prostate, d, is considerably enlarged, and the vesical orifice is girt by a prominent ring, b b, from the right border of which the nipple-shaped body, a, projects and occupies the outlet.

Owing to the retention of urine caused by this state of the prostate, the ureters, c c, have become very much dilated.

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Plate 61.--Figure 5.

Fig. 6, Plate 61.--The lateral lobes of the prostate, c c, are seen enlarged, and from the inner side and base of each, irregularly shaped ma.s.ses, a, b, d, project, and bend the prostatic urethra first to the right side, then to the left. The part, a, resting upon the part, b, acts like a valve against the vesical outlet, which would become closed the tighter according to the degree of superinc.u.mbent pressure. A flexible catheter would, in such a case as this, be more likely, perhaps, to follow the sinuous course of the prostatic pa.s.sage than a rigid instrument of metal.

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Plate 61.--Figure 6.

Fig. 7, Plate 61.--A globular ma.s.s, a, of large size, occupies the neck of the bladder, and gives the vesical orifice, c, a crescentic shape, convex towards the right side. The two lobes of the prostate, b, are much enlarged.

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Plate 61.--Figure 7.

Fig. 8, Plate 61.--The lateral lobes, b b, of the prostate are irregularly enlarged, and the urinary pa.s.sage is bent towards the right side, c, from the membranous portion, which is central. Surmounting the vesical orifice, c, is seen the tuberculated ma.s.s, a, which being moveable, can be forced against the vesical orifice and thus produce complete retention of urine. In this case, also, a flexible catheter would be more suitable than a metallic one.

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Plate 61.--Figure 8.

Fig. 9, Plate 61.--The lateral lobes, b b, of the prostate are enlarged.

The third lobe, a, projects at the neck of the bladder, distorting the vesical outlet. A small calculus occupies the prostatic urethra, and being closely impacted in this part of the ca.n.a.l, would arrest the progress of a catheter, and probably lead to the supposition that the instrument grated against a stone in the interior of the bladder, in which case it would be inferred that since the urine did not flow through the catheter no retention existed.

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