Gynaecology for students and practitioners . nastomosis, or (6) by the removal of thekidney on the affected side, the other kidney having first been demon-strated to be present and functionally active by catheterization of thelu-eter and urinary analysis. Only under exceptionally favourableconditions is the former likely to be successful. Vesico-vaginal fistulse PLASTIC OPERATIONS 827 and recto-vaginal fistulse can usually be dealt with by plastic operationswhich may now be described. Vesico-Vaginal Fistulse. The majority of these fistulae affect theupper and middle thirds of the anterior vagi
Gynaecology for students and practitioners . nastomosis, or (6) by the removal of thekidney on the affected side, the other kidney having first been demon-strated to be present and functionally active by catheterization of thelu-eter and urinary analysis. Only under exceptionally favourableconditions is the former likely to be successful. Vesico-vaginal fistulse PLASTIC OPERATIONS 827 and recto-vaginal fistulse can usually be dealt with by plastic operationswhich may now be described. Vesico-Vaginal Fistulse. The majority of these fistulae affect theupper and middle thirds of the anterior vaginal wall, and can be closedby an operation per vaginam. A small number are situated higher thanthis, and are accompanied by more or less destruction of the anteriorcervical wall. In these, the hole in the bladder may be situated so highthat it can be best reached by an intra-peritoneal supra-pubic consists in separating the bladder from the uterus and vagina,beginning above and extending well down below the level of the lower. Fig. 501. Elevated Pelvic Position for Operation for Vesico-vaginalFistula (after Kelly). border of the fistula ; the aperture in the bladder is then closed, andafterwards that in the vagina. The operation is formidable owing tothe difficulty in obtaining access to the parts. The procedures which may be practised for those situated in themiddle or lower third {see Fig. 500) of the vagina are as follows : The operation suitable for moderate-sized fistulee, involving onlythe vaginal wall and bladder, is simple and easy. In order to obtain agood view of the anterior vaginal wall it is advisable to employ theelevated pelvic position shown in Fig. 501. The posterior vaginalwall being then held back by a flat retractor the fistula can be well seen(Fig. 500). Two different methods of closure may be practised : {a) inone the edges of the fistula are simply rawed and then stitchedtogether ; (b) in the other, a flap-splitting method, the bladder andv
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
