T HE young doctor is amazed at the great diversity of informed opinions which exist regarding the management of the obstructing prostate. A new procedure is devised and shortly thereafter numerous reports appear in the Iiterature of long series of cases with littIe or practically no mortahty or morbidity. Such shouId indicate the advent of the perfect operation. However, within a few years another type of approach repIaces that one in popuIarity. No operation in the reaIms of surgery has a more vigorousIy divided group of advocates than the four types of operation on the prostate gIand. Each has its pIace, and the uroIogist shouId be familiar with a11 and seIect the one that is most suitabIe to the patient’s condition. The accuracy of statistics depends upon the reporter; comphcations are frequentIy overlooked or minimized due to poor foIIow-ups. ApparentIy technic aIone, rather than anatomic and physioIogic fundamentaIs, has been featured by those who advocate that a uroIogic surgeon Iimit his practice to one of the stereotyped procedures. There are onIy two reasons for performing a prostatectomy : (I) reIief of urinary obstructions and (2) cure of early cancer of the prostate. In the fir-rat anaIysis the surgeon asks himself whether if he were the patient he wouId have the operation performed; and we must not forget that very few uroIogists have had prostatectomies. Morbidity not mortaIity is of primary interest. Benign hypertrophy of the prostate is undoubtedIy due to endocrine imbaIance since it deveIops onIy in those who have testicIes. It is regarded by some as a true adenomatous tumor and others as a seniIe hyperpIasia of the normal eIements of the prostate. From the standpoint of the surgeon the matter is whoIIy academic. Too often the bad operative resuIts are directIy due to abysma1 ignorance of anatomy. FundamentaIIy the prostate is the muscuIar neck of the bladder which has been invaded by gIand tubuIes. (Fig. I.) The prostate consists of an extension of the two Iayers of smooth muscIe fibers of the bIadder waI1 which have been invaded by prostatic gIand tubules. It has two “sphincters,” one proxima1 and the other dista1. A true sphincter is a muscIe whose origin and insertion is in itseIf. Hence the bIadder has a true externa1 sphincter made up of striated muscIe fibers but there is no true interna sphincter. The term is merely a surgica1 designation and does not refer to an anatomic entity. The bIadder has an internal circular and an externa1 IongitudinaI Iayer of smooth muscIes which are not perfectIy defined. The vesical orifice is cIosed by two loops or arcs of smooth muscIe fibers, one arising from the interna circuIar Iayer, commonIy designated as the interna arcuate muscIe of the vesica1 orifice, and the other from the externa1 Iongitudinal Iayer of the bIadder waI1 or the externa1 arcuate muscIe of the vesica1 orifice. (Fig. 2.) Fibers of the interna circuIar Iayer form a loop about the urethra. From the region posterior to the vesica1 orifice they swing downward and forward in an obIique direction, passing as thin bands inside the Ioop of the externa1 Iongitudina1 muscIes heretofore described and around the urethra in the region generaIIy opposite the verumontanum where they form an arc in front of the urethra. The action of the so-caIIed interna sphincter is due to the tonsiIIotome-Iike contraction of the two loops. In the base of the bIadder there is in addition the trigonal muscIe. It is a continuation of the externa1 IongitudinaI Iayer of the, two ureters that interIace and ffow downward through the interna vesica1 orifice to the verumontanum. The externa1 IongitudinaI and interna circuIar Iayers arise from tissues of entodermal origin whereas the trigona1 muscIe is of mesoderma1 origin. Some of the fibers of the externa1 IongitudinaI layer pass down aIong the posterior surface of the bIadder unti1 they reach the region of the trigone. There they sweep up toward the vesical