File:The Principles and practice of gynecology - for students and practitioners (1904) (14581670877).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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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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Fistula being closed by union of vesical plate of the vesicovagiual wall; this leaves thevaginal plate still open. Latere. repair the whole vaginal part of the injury and to leave the uterinepart open. Figure 292 shows the sinus extending from the bladderto the interior of the uterus. The Diagnosis and Treatment of Vesico-uterine Fistula. The diagno.sis is based upon the history of the case and the passageof urine through the os externum. The treatment is to reproduce the 604 TRAUMATISMS. original tear by an incision through the anterior lip of the cervixdirectly into the sinus. The fistula thus exposed at the angle of theincision is denuded, and the whole wound, including the fistula andthe cervical laceration, is closed with silkworm gut sutures. Exceptthat the sutures, in addition to closing the cervix, are made also toclose the opening into the bladder, the operation does not differ fromthe ordinary operation for closure of an anterior laceration of thecervix uteri.^ URETHROVAGINA

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