. Atlas and epitome of gynecology . Fig. 26.—Incomplete prolapse of the uterus ; inversion of thevagina from perineal tear of the third degree (into the rectum). Theos is notched (photograph from original water-color). If the prolapse is beyond the preventive stage, an ap-parently rational therapy—from our knowledge of thesupports of the internal genitalia (based upon the authorsexperiments and those of Kimmel 1)—would be the 1 Kimmel, Inaug. Dis., 1894, Heidelberg. 66 VAGINAL AND UTERINE PROLAPSE. strengthening of the muscles of the pelvic floor by mass-age. This has, nevertheless, been follo
. Atlas and epitome of gynecology . Fig. 26.—Incomplete prolapse of the uterus ; inversion of thevagina from perineal tear of the third degree (into the rectum). Theos is notched (photograph from original water-color). If the prolapse is beyond the preventive stage, an ap-parently rational therapy—from our knowledge of thesupports of the internal genitalia (based upon the authorsexperiments and those of Kimmel 1)—would be the 1 Kimmel, Inaug. Dis., 1894, Heidelberg. 66 VAGINAL AND UTERINE PROLAPSE. strengthening of the muscles of the pelvic floor by mass-age. This has, nevertheless, been followed by but fewpermanent results. At the present time it is better to treatthese cases with the pessary or by operation. The operative treatment is radical and sure. In retro-deviations the uterus is brought forward into its normal. Fig. 27.—Complete prolapse of a retroflexed uterus, with os is notched (photograph from original water-color). position by retrofixatio colli uteri, with or without open-ing of the recto-uterine pouch; by shortening the roundligaments, either in the inguinal canal or after an anteriorcolpotomy. By the latter route the broad ligaments maybe shortened or a thickened uterus may be anteflexed by TREATMENT. 67 excision of a wedge-shaped piece from its anterior the menopause the uterus may be separated from thebladder and stitched to the vagina or bladder (vaginofixa-tion or vesicofixation of Diihrssen, Mackenrodt). If theorgan is held by strong adhesions, or if the ligaments and
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