File:Annals of surgery (1885) (14587159099).jpg

Identifier: annalsofsurgery31philuoft (find matches)
Title: Annals of surgery
Year: 1885 (1880s)
Authors:
Subjects: Surgery
Publisher: Philadelphia Lippincott
Contributing Library: Gerstein - University of Toronto
Digitizing Sponsor: University of Toronto

View Book Page: Book Viewer
About This Book: Catalog Entry
View All Images: All Images From Book
Click here to view book online to see this illustration in context in a browseable online version of this book.

Text Appearing Before Image:
iego was called to see thecase. Dr. Samaniego had Dr. F. W. Gallagher in consultation, andthese two gentlemen kindly referred the case to me for operation.On examination, the urethra and bladder were found completely dis-connected, the urethra being a functionless tube. The opening intothe bladder was about a half-inch in diameter, the distance betweenthe lower part of this opening and the lower part of the urethra one7 97 98 /. SHELTON HORSLEY. and a half inches, and between the upper part of the vesical openingand the upper part of the urethra a half-inch. In other words, therehad sloughed out a triangular mass of tissue, including part of theneck of the bladder and the whole thickness of the urethra, with itsbase towards the vagina and apex, behind the symphysis pubis. Cys-tocele was present. Operation performed April 25, 1899, under chloroform anaes-thesia. Patient was placed in the Simss position. I had at firstexpected to dissect the bladder from the uterus and possibly from the
Text Appearing After Image:
vagina, but an ample cystocele permitted approximation of the partswithout too much tension. I first denuded the tissues around theopening in the bladder down to the vesical mucous membrane; then,so as to make the diameter of the opening in the urethra equal tothat in the bladder, and at the same time to get rid of someirregular scar tissue, the urethra was cut obliquely (as shown in thefigure). Two silk sutures wer6 inserted, going through the mucousmembrane and muscular coat of the bladder and the upper part ofthe urethra (A in the cut). These approximated the upper part of VESICO-URETHRO-VAOINAL FISTULA. 99 the vesical opening and the corresponding portion of the urethra.Then four sutures of fine silkworm gut coapted the lower portion ofthe vesical and urethral openings (B). These did not penetrate themucous membrane. On account of the existing cystocele the blad-der could be readily pulled forward. A catheter was then insertedthrough the urethra and another through a small incisio

Note About Images