File:Treatise on gynaecology - medical and surgical (1894) (14780381162).jpg

Identifier: treatiseongynaec02pozz (find matches)
Title: Treatise on gynaecology : medical and surgical
Year: 1894 (1890s)
Authors: Pozzi, Samuel, 1846-1918 Wells, B. H., tr
Subjects: Gynecology Generative organs, Female Women Gynecology Genital Diseases, Female Gynecologic Surgical Procedures
Publisher: New York : William Wood & Co.
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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t throughthe urethra. After this, an annfilar denudation is done about thefistula, leaving intact in its immediate neighborhood a zone of mucousmembrane of about three or four millimetres diameter. As a result, 328 CLINICAL AND OPERATIVE GYNECOLOGY. after snturing, tlie edges of tlie fistula, covered witli intact mucousmembrane, were turned into tlie bladder, forming a gutter-like depres-sion, at the extremity of which the ureter opened. Recovery followedafter a series of complications. There is another j)rocedure analogous to denudation which hasbeen resorted to twice by Professor Trelaf^^ without catheterizationof the ureter. It seems to me also that the preliminary formation ofa vesical fenestra and the introduction of the ureteral sound is not asessential in this case as in Landaus operation. Operation hy ^olitting?^—In a case of uretero-vaginal fistulawhere the patient had been operated upon already eleven times bythe ordinary procedure, I was able to establish the diagnosis by
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Fig. 98.—Schedes Operation for Uretero-vaginalFistula. (Schematically drawn.) Fig. 99.—Operation by Splitting forUretero-vaginal Fistula. introducing Pawliks ureteral sound to the depth of twenty-one cen-timetres. The vesico-uretero-vaginal orifice was small, so that it wouldbarely admit the hysterometer. I performed the operation of divi-sion recommended by Gerdy and applied by Blasius, Duboue, Collis,von Heril, Walcher, and others to the ordinary vesico-vaginal fistulse.I believe that it served here a special purpose by allowing the rejDlace-ment of the ureteral orifice in the bladder without danger of inclusionin the sutures. I proceeded in the following manner: Placing thepatient in the genu-pectoral position, I made a transverse incision inthe neighborhood of the fistula, carrying it about three-tenths of aninch beyond the fistula upon each side. I then made a vertical inci-sion at each extremity, so as to give to the whole the form of the letterH (lying sidewise I), and diss

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