134 Commentary on plates 61 & 62.

Fig. 1, Plate 61.--The prostate, a b, is here repre­sented thinned in its walls above and below. The lower wall is dilated into a pouch caused by the points of misdirected instruments in catheterism having been rashly forced against it.

Plate 61.--Figure 1.

Fig. 2, Plate 61.--The prostate, a b, is here seen to be somewhat more enlarged than is natural. A tuber­cle, b, surmounts the lower part, c, of the prostate, and blocks up the vesical orifice. Catheters intro­duced by the urethra for retention of urine which existed in this case, have had their points arrested at the bulb, and on being pushed forwards in this direc­tion, have dilated the bulb into the form of a pouch, seen at d. The sinus of the bulb, being the lowest part of the urethral canal, is very liable to be distorted or perforated by the points of instruments descending upon it from above and before. [Footnote]

[Footnote: When a stricture exists immediately behind the bulb, this circumstance will, of course, favour the occurrence of the accident. "False passages (observes Mr. Benjamin Phillips) are less frequent here (in the membranous part of the urethra) than in the bulbous portion of the canal. The reason of this must be immediately evident: false passages are ordinarily made in consequence of the difficulty experienced in the endeavour to pass an instrument through the strictured portion of the tube. Stricture is most frequently seated at the point of junction between the bulbous and membranous portions of the canal; consequently, the false passage will be usually anterior to this latter point."--(On the Urethra, its Diseases. &c., p. 15.) ]

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.

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 canal and vesical opening.

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.

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 masses, 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 superincumbent pressure. A flexible catheter would, in such a case as this, be more likely, perhaps, to follow the sinuous course of the prostatic passage than a rigid instrument of metal.

Plate 61.--Figure 6.

Fig. 7, Plate 61.--A globular mass, 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.

Plate 61.--Figure 7.

Fig. 8, Plate 61.--The lateral lobes, b b, of the pros­tate are irregularly enlarged, and the urinary passage is bent towards the right side, c, from the membranous portion, which is central. Surmounting the vesical orifice, c, is seen the tuberculated mass, 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.

Plate 61.--Figure 8.

COMMENTARY ON PLATES 61 & 62. 135

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 canal, 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.

Plate 61.--Figure 9. Plate 61.--Figure 10.

Fig. 10, Plate 61.--Both lateral lobes, b c, of the prostate appear much increased in size. A large irre­gular shaped mass, a, grows from the base of the right lobe, and distorts the prostatic canal and vesical orifice. When the lobes of the prostate increase in size in this direction, the prostatic canal becomes much more elongated than natural, and hence the instrument which is to be passed for relieving the existing reten­tion of urine should have a wide and long curve to correspond with the form of this part of the urethra. [Footnote]

[Footnote: Both lobes of the prostate are equally liable to chronic enlargement. Home believed the left lobe to be oftener in­creased in size than the right. Wilson (on the Male Urinary and Genital Organs) mentions several instances of the enlarge­ment of the right lobe. No reason can be assigned why one lobe should be more prone to hypertrophy than the other, even supposing it to be matter of fact, which it is not. But the observations made by Cruveilhier (Anat. Pathol.), that the lobu­lated projections of the prostate always take place internally at its vesical aspect, is as true as the manner in which he accounts for the fact is plausible. The dense fibrous envelope of the prostate is sufficient to repress its irregular growth externally.]

Fig. 11, Plate 61.--Both lobes of the prostate are enlarged, and from the base of each a mass projects pro­minently around the vesical orifice, a b. The prostatic urethra has been moulded to the shape of the instru­ment, which was retained in it for a considerable time.

Plate 61.--Figure 11.

Fig. 12, Plate 61.--The prostate, c b, is enlarged and dilated, like a sac. Across the neck, a, of the bladder the prostate projects in an arched form, and is transfixed by the instrument, d. The prostate may assume this appearance, as well from instruments having been forced against it, as from an abscess cavity formed in its substance having received, from time to time, a certain amount of the urine, and retained this fluid under the pressure of strong efforts, made to void the bladder while the vesical orifice was closed above.

Plate 61.--Figure 12.

Fig. 13, Plate 61.--The lateral lobes, d e, of the prostate are enlarged; and, occupying the position of the third lobe, appear as three masses, a b c, plicated upon each other, and directed towards the vesical orifice, which they close like valves. The prostatic urethra branches upwards into three canals, formed by the relative position of the parts, e, c, b, a, d, at the neck of the bladder. The ureters are dilated, in con­sequence of the regurgitation of the contents of the bladder during the retention which existed ..

Plate 61.--Figure 13.

Fig. 1, Plate 62, exhibits the lobes of the prostate greatly increased in size. The part, a b, girds irregu­larly, and obstructs the vesical outlet, while the lateral lobes, c d, encroach upon the space of the prostatic canal. The walls of the bladder are much thickened.

Plate 62.--Figure 1.