In the
lateral operation, the incision C through the integument, crosses at an
acute angle the deeper incision D, which divides the neck of the
bladder, the prostate, &c. The left lobe of the prostate is divided
obliquely in the lateral operation; both lobes transversely in the
bilateral.

[Illustration: Abdomen, showing blood vessels and other internal organs.]
Plate 54, Figure 1.

Fig. 2, Plate 54.--If the artery of the bulb happen to arise from the
pudic opposite the tuber ischii, or if the inferior hemorrhoidal
arteries be larger than usual, these vessels crossing the lines of
incision in both operations will be divided. If the superficial lateral
incision C, Fig. 1, be made too deeply at its forepart, the artery of
the bulb, even when in its usual place, will be wounded; and if the deep
lateral incision D be carried too far outwards, the trunk of the pudic
artery will be severed. These accidents are incidental in the bilateral
operation also, in performing which it should be remembered that the
bulb is in some instances so large and pendulous, as to lie in contact
with the front of the rectum.

[Illustration: Abdomen, showing blood vessels and other internal organs.]
Plate 54, Figure 2.

Fig. 1, Plate 55.--When the pudic artery crosses in contact with the
prostate, F, it must inevitably be divided in either mode of operation.
Judging from the shape of the prostate, I am of opinion that this part,
whether incised transversely in the line B B, or laterally in the line
D, will exhibit a wound in the neck of the bladder of equal dimensions.
When the calculus is large, it is recommended to divide the neck of the
bladder by an incision, combined of the transverse and the lateral. The
advantages gained by such a combination are, that while the surface of
the section made in the line D is increased by "notching" the right lobe
of the prostate in the direction of the line B, the sides of both
sections are thereby rendered more readily separable, so as to suit with
the rounded form of the calculus to be extracted. These remarks are
equally applicable as to the mode in which the superficial perinaeal
incision should be made under the like necessity. If the prostate be
wholly divided in either line of section, the pelvic fascia adhering to
the base of this body will be equally subject to danger. By incising the
prostate transversely, B B, the seminal ducts, G H, which enter the base
of this body, are likewise divi