Inhaltsangabe
This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1898 edition. Excerpt: ...it may be cured by denudation and suture of the external os or the lower part of the cervix (hysterocleisis, Jobert). A great disadvantage of this method is that the menstrual blood is discharged through the fistula into the bladder. Vesico-utero-vaginal fistulas at the place of reflection of the cervix on to the vaginal fornix are closed by freshening and suturing the anterior wall of the cervix and the opposed vaginal mucous membrane in a transverse direction. In large defects of the anterior lip of the cervix the anterior and posterior lips should be freshened and united longitudinally to the previously denuded mucous membrane of the vagina (Hegar), or the posterior lip may be sutured to the lower edge of the fistula, 60 that the cervix communicates with the bladder. All vesico-vaginal fistula? which can not be healed by operating within the vagina should be closed within the bladder after performing suprapubic cystotomy. The patient is given the Trendelenburg position. Fistula? or large defects may also be closed by means of a pedunculated flap taken from the posterior vaginal wall (Trendelenburg). After the flap has healed into the defect, which requires a few weeks, its pedicle is divided and the fistula or defect closed on all sides. The urine is temporarily evacuated by suprapubic drainage. In suitable cases of vesico-vaginal fistula the bladder may 1m? detached from the vagina as completely as possible and each sutured separately (Herczel). In case of large defects of the urethra an attempt may be made to form a new urethra by cutting a flap from the neighbouring mucous membrane or from the external genitals (Fritsch). Small defects may be closed by denudation and suture of the upper and lower portion of the urethra. In case of...
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