File:Operative gynecology - (1906) (14596959138).jpg

Identifier: operativegynecol001kell (find matches)
Title: Operative gynecology :
Year: 1906 (1900s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943
Subjects: Gynecology Gynecology Gynecologic Surgical Procedures
Publisher: New York and London : D. Appleton and company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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s scratched orgouged on coming intocontact with a stone. 490 AFFECTIONS OF THE URETERS. is curved in an opposite direction from the curve of the point, so as to keepthe fingers out of the way during introduction. At the outer end there is alittle bulbous enlargement to hold rubber tubing slipped over it; a plug andchain are attached to keep the catheter closed until introduced. The sizes varyin diameter from 2^ to 6 mm., the difference between the sizes being half a mm.Introduction of the Speculum and Location of the UreteralOrifices.—The bladder is first emptied of its urine by voiding it in a sittingor a standing posture. The evacuation is more complete when it is so voidedthan when drawn by catheter in the dorsal posture. The patient is then placedon a table in the knee-chest or elevated-dorsal position, the labia separated, and the urethral orifice exposed and cleansedwith a boric acid solution to avoid carry-ing surface contamination into the bladderon introducing the speculum.
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Fig. 277.—Sounding the Left Ureter with the Searcher before introducing the Catheter.The patient is in the elevated-dorsal position, and the electric headlight is used to illuminate the bladder. A bladder speculum, JSTo. 8, 9, or 10, is introduced as described in ChapterXVII. The light is then reflected into the bladder, and illuminates the poste-rior wall. The speculum is next withdrawn until the internal urethral orificebegins to close over the end, when it is pushed farther in, about a centimeter,and turned from 25 to 30 degrees, either to the right or left, while the handleis dropped to bring the base of the bladder into view. The ureter itself, orthe area immediately adjacent to it, now lies within the field of vision, about CATHETERIZATION. 491 1.5 cm. (-J inch) distant from the end of the speculum. In thin patients thedorsal posture works very well, but in a patient of medium size the bladdermay not distend well until she assumes the knee-chest position. Stout womenmust alway

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