. Gynecology : . osteriorly. As the elongated cervix is developed the fibers of theimportant cardinal ligaments are brought into view, unless they have been tornor stretched away during the process of the uterine prolapse. When the cervix has been fully developed attention is directed to the Cushing stitch is applied well out on the sides of the cystocele so as to infoldthe central part of the protruding cystocele: Care should be taken that the OPERATIONS ON THE VAGINA 623 suture includes at each bite a firm hold of the fascia which invests the passing the stitch at the le
. Gynecology : . osteriorly. As the elongated cervix is developed the fibers of theimportant cardinal ligaments are brought into view, unless they have been tornor stretched away during the process of the uterine prolapse. When the cervix has been fully developed attention is directed to the Cushing stitch is applied well out on the sides of the cystocele so as to infoldthe central part of the protruding cystocele: Care should be taken that the OPERATIONS ON THE VAGINA 623 suture includes at each bite a firm hold of the fascia which invests the passing the stitch at the level of the neck of the bladder the needle is carrieddeeply into the firm tissue which lies at the sides of the urethra. This serves torectify the functional incontinence with which many of these patients aretroubled. It is a good plan at this stage to introduce the retention mattressstitch depicted on page 618. When the protruding cystocele has been implicatedthe amputation of the cervix follows as the next Fig. 264.—Amputation of the Cervix and Anterior Colpoplasty (Studdiford).The cervix has been bisected and the two lips are to be amputated by wedge-shaped incisions. The cervix is first bisected by a lateral incision up to the point selected forthe amputation. The lips are drawn apart as in Fig. 264. Each lip is separatelyamputated by a wedge-shaped incision as depicted in the drawing, so as to leavetwo pouting projections on each lip (Fig. 264). The object of this is to securean everting tube-shaped opening for the uterine canal. Two catgut sutures are placed first through the posterior cervical lip-stump 624 GYNECOLOGY and into the vaginal wall of corresponding points (Fig. 265) and tied. Twosutures are then placed through the anterior stump and including the angles ofthe vaginal flaps at each side of the original longitudinal incision. Sutures areplaced at the angles of the cervical stump and into the edges of the mucous mem-brane on each side (Fig. 266). The fin
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