File:Gynaecology for students and practitioners (1916) (14801784513).jpg

Identifier: gynaecologyforst00eden (find matches)
Title: Gynaecology for students and practitioners
Year: 1916 (1910s)
Authors: Eden, Thomas Watts, 1864-
Subjects: Gynecology Gynecology
Publisher: New York : Macmillan
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons

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ever, be considered. Fistulous tracts which are lined by mucous membrane showlittle or no tendency to close spontaneously, while those which arelined only by granulation-tissue show a strong tendency towardsrepair. Vaginal fistulse, both urinary and fsecal, belong to theformer class; all the abdominal fistulae and the ano-perinealfistulse belong to the latter class. While operation is consequentlyalways indicated in the former class, the latter should be leftalone as long as they show any tendency towards progressiverepair. In the case of urinary fistulse the success of operative procedmes 826 GYNECOLOGY depends to a great extent upon the condition of the urine being healthy.Consequently urinary infection must be carefully treated and com-pletely corrected before operation is undertaken. In the case of f^calfistulse no such precautions are practicable. The operations required for abdominal fcecal fistulce are difficultand complicated procedures which cannot be described here. Ureteral
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Fig, 500. Vesico-Vaginal Fistula exposed foe Operation. fistulcE whether vaginal or abdominal are to be dealt with either (a) bytransplantation of the proximal end of the damaged ureter into thebladder—Mfe^ero-^es^caZ anastomosis, or (6) by the removal of thekidney on the affected side, the other kidney having first been demon-strated to be present and functionally active by catheterization of thelu-eter and urinary analysis. Only under exceptionally favourableconditions is the former likely to be successful. Vesico-vaginal fistulse PLASTIC OPERATIONS 827 and recto-vaginal fistulse can usually be dealt with by plastic operationswhich may now be described. Vesico-Vaginal Fistulse. The majority of these fistulae affect theupper and middle thirds of the anterior vaginal wall, and can be closedby an operation per vaginam. A small number are situated higher thanthis, and are accompanied by more or less destruction of the anteriorcervical wall. In these, the hole in the bladder may be sit

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