File:Gynecological diagnosis (1910) (14778191685).jpg

Identifier: gynecologicaldia00burr (find matches)
Title: Gynecological diagnosis
Year: 1910 (1910s)
Authors: Burrage, Walter L. (Walter Lincoln), 1860-1935
Subjects: Women
Publisher: New York, London, D. Appleton and Company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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there is more orless incontinence on coughing,laughing, and straining. There may be residual urine in a dislo-cated bladder with consequent cystitis. This is rare. Diagnosis.—There may or may not be evidence of bulging ofthe anterior wall of the vagina when the introitus vaginae isinspected with the patient in the dorsal position. Straining bringsthe anterior wall into view, however. A curved sound introducedthrough the urethra shows the situation of the base of the bladderas determined by palpation of its tip under the anterior vaginalwall. The extent of the prolapse may be estimated by examiningthe patient in the standing position and asking her to strain whilethe examination is made. In the knee-chest position the cystoceledisappears. In large cystoceles the vaginal wall is thickened andhas the appearance of skin. In prolapse of the uterus it may beulcerated. Differential Diagnosis.—We must distinguish cystocele fromcyst or other tumor of the vagina, hypertrophy of the bladder
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Fig. 148.—Cystocele. 368 DISEASES OF THE VAGINA wall in chronic cystitis, sub-urethral abscess, and true intestinalhernia of the vagina. Tumor of the anterior vaginal wall does notincrease in size or tension on straining and coughing, it does notdisappear on pressure or on putting the patient in the knee-chestposition, filling the bladder has no effect on the size or elasticityof the tumor, and palpation of a sound in the bladder shows thatthere is something besides the walls of the bladder and vaginabetween the tip of the sound and the examiners finger in thevagina. Hypertrophy of the bladder wall in chronic cystitis to the extentof forming a tumor in the vagina is rare. The diagnosis of cystitisby means of the cystoscope and examination of the urine, together

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