File:The Principles and practice of gynecology - for students and practitioners (1904) (14581669347).jpg

Identifier: principlespracti00dudl (find matches)
Title: The Principles and practice of gynecology : for students and practitioners
Year: 1904 (1900s)
Authors: Dudley, E. C. (Emilius Clark), 1850-1928
Subjects: Gynecology
Publisher: Philadelphia : Lea Brothers & Co.
Contributing Library: Columbia University Libraries
Digitizing Sponsor: Open Knowledge Commons

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n was complete. Thebladder, although reduced in size by the operation, has normally per-formed its functions ever since. It is large enough to enable thewoman to retain her urine all night. The writer is not aware thatanother similar operation has been recorded. Howard Kelly suggests a plan which might be adopted to advan-tage in place of the one just described. It is to dissect the bladderentirely free from the uterus, so as to make a wide opening betweenthe vagina and the peritoneum—that is, to make an anterior vaginalsection into the peritoneal cavity. The bladder-wall, anterior to the37 602 TRAUMATISMS. uterus, thus freed from its uterine attachments, may then be drawndown so as to close the fistula by a transverse line of sutures. Sincethe bladder-wall is covered with peritoneum, and since peritoneal sur-faces are very prone to unite readily, such an operation would be veryapt to succeed. After closure of the fistula the wound anterior to theuterus should be closed. Figure 333.
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Shows act of splitting margins of fistula preparatory to approximating the fragments of thevesical plate of the vesicovaginal wall. Lateroprone position and Sims speculum. Another possible method, suggested by Mackinrodt/ for such casesis to detach the vesical from the vaginal )ilate of the vesicovaginalwall and to close the fistula by suturing together the vesical plateindependentlv, leaving the vaginal plate open to heal by o:ranulation.Figures 33-3 *and 334^ 1 Centrablatt fiir Gynakologie, No. 8, 1894; from Kelly. GENITAL FISTULJE.VESICOUTERINE FISTULA. 603 This form of fistula has l)oen nicntioiuMl in tlic chapter on Lacer-ation of the Cervix ; it is tiie result of anterior laceration of thecervix extending into the bladder. Usually the eifort of nature torepair produces union in tlie lower part of the laceration so as to Figure o34.

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