. Gynecology : . Fig. 247.—Anterior Colpoplastt. points are marked in the mucous membrane. The points G and C are nextselected. These are also chosen so that when approximated in the middleline the anterior part of the cystocele will be approximated. These points,G and C, are always closer together than F and D, because the vagina shouldnot be drawn too tightly near the introitus. The point E is in the central line,just at the reflection of the vaginal mucous membrane from the portio of thecervix. When the points have been carefully marked, the area included betweenE, D, C, G, and F is denuded
. Gynecology : . Fig. 247.—Anterior Colpoplastt. points are marked in the mucous membrane. The points G and C are nextselected. These are also chosen so that when approximated in the middleline the anterior part of the cystocele will be approximated. These points,G and C, are always closer together than F and D, because the vagina shouldnot be drawn too tightly near the introitus. The point E is in the central line,just at the reflection of the vaginal mucous membrane from the portio of thecervix. When the points have been carefully marked, the area included betweenE, D, C, G, and F is denuded with Emmets scissors. Experience has shown 39 610 GYNECOLOGY that this method of denudation is safer, more rapid, and more satisfactory thanremoval of the mucous membrane by the splitting of a flap. When the areahas been denuded a suture is first placed, entering the mucous membrane at Dt. Fig. 248.—Operation for Cystocele. Anterior Colpoplasty. (Authors method.)The amount of cystocele is determined by folding the redundant wall in the manner here pressing the thumb forceps four landmarks are made in the mucous membrane which serve as aguide to the denudation. These four marks correspond to the points A, B, C, and D in the diagram(Fig. 247). passing across the cystocele, and issuing at F. The ends of the suture are clampedand drawn sharply upward by the assistant. This approximates and bringsinto easy reach the edges E-F and E-D, which are then united by several inter-rupted sutures. OPERATIONS ON THE VAGINA 611 The first stage of the operation is now completed, and should result in reduc-ing the posterior part of the cystocele and drawing a tight bar of tissue acrossthe front of the cervix. The second stage of the operation is directed to theanterior part of the cystocele which includes the urethra. This portion isusually protuberant, though the prominenc
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