Transvesical prostatectomy in two stages : with remarks upon the pathology and clinical phases of prostatic obstruction / by Paul Monroe Pilcher.

  • Pilcher, Paul M. (Paul Monroe), 1876-1917.
Date:
[1914], ©1914
Catalogue details

Licence: Public Domain Mark

Credit: Transvesical prostatectomy in two stages : with remarks upon the pathology and clinical phases of prostatic obstruction / by Paul Monroe Pilcher. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

    18/82 (page 10)
    Ill this case we had the obstruction of the enlarged mass and in addition a ball valve action. Fig. 12 is the photograph of a specimen, actual size, re- moved in one piece. It is a perfect example of hypertrophy of both lateral lobes of the prostate. Fig. 13 shows a section through the centre of this mass and shows quite distinctly the three lobes, the two lateral lobes and the median lobe, and their position in relation to the urethra. The median lobe extends up like a wedge between the two lateral lobes and is only moder- ately enlarged. In this connection reference may be made to the series of photographs of specimens which were published in 1888 by Francis S. Watson, of Boston, in his treatise on the Operative Treatment of Hypertrophy of the Prostate, Plate 4 (reproduced here as Fig. 14) shows a very important feature; the lateral lobes are moderately enlarged, the median lobe is distinctly enlarged and is projecting into the bladder, forming the cause of the obstruction. Distal to the median lobe enlarge- ment is seen a raised-up portion, which is the colliculus or veru- montanum, at which point the vasa deferentia empty into the urethra. If the finger is introduced into the urethra by the transvesical route in enucleating the prostate, one can easily see from the specimen how the colliculus may be preserved. Fig. 15 is an undeniable example of hypertrophy of both the lateral and median lobes of the prostate. This specimen, which is a dissection not only of the prostate but of the bladder as well, shows exactly the relation which no drawing could so well express. Fig. 16 shows another phase which is a bilateral hypertrophy of the prostate with a slight median lobe develop- ment causing a distinct prostatic bar. The tortuous course of the urethra, the presence of the colliculus and its relative posi- tion are clearly shown. No one could argue that in these speci- mens such a hypertrophy originates from the median lobe alone. The floor of the urethra is very clearly shown and is seen to be free from all hypertrophied tissue. This portion of the urethra must invariably be involved, at least that portion between the colliculus and the sphincter, in all median lobe enlargements. Fig. 17 is a perfect example of median lobe enlargement alone.