. Manual of operative surgery. ase of the malformed foreskin(Fig. 837, X). By making the glans penis passthrough the hole in the foreskin the latter isbrought on to the dorsum of the penis and itstissue can be used to cover the raw surface onthe back of the new-formed dorsum of thepenis. III. Rutkowskis Operation.—Rutkowskisoperation and the similar one of Mikulicz havebeen used with more or less success in the treat-ment of exstrophy. They will be found suf-ficiently described in the pages devoted torepair of defects in the bladder-wall. IV. Sonnenburg, in a case ifi which the ex-posed vesica
. Manual of operative surgery. ase of the malformed foreskin(Fig. 837, X). By making the glans penis passthrough the hole in the foreskin the latter isbrought on to the dorsum of the penis and itstissue can be used to cover the raw surface onthe back of the new-formed dorsum of thepenis. III. Rutkowskis Operation.—Rutkowskisoperation and the similar one of Mikulicz havebeen used with more or less success in the treat-ment of exstrophy. They will be found suf-ficiently described in the pages devoted torepair of defects in the bladder-wall. IV. Sonnenburg, in a case ifi which the ex-posed vesical mucosa protruded greatly, andin which no urinal could be used, operated inthe following manner: Make an incision allaround the exposed mucous membrane, andthrough this cut dissect the mucosa from theabdominal parietes, but do not injure theperitoneum. Remove the mucosa completely. Dissect the lower ends of the ureters from the surrounding structuressufficiently to permit their implantation into the upper end of the Fig. 837.—Segonds operation.{FarabeuJ.) ECTOPIA VESICA 677 which represents the urethra, and fix them there with sutures. Close thedefect left in the abdominal wall by flaps slid over from its sides. V. Maydls Operation.—Excise all the exposed vesical mucosa exceptthat portion immediately around the orifices of the ureters (Fig. 838). Carefullycleanse the wound and field of operation after the excision of the filthymucous membrane. Open the abdomen. Find the sigmoid and bring a loopof it out of the wound. By stripping, empty the gut of its contents. Apply anintestinal clamp or tape above and below the part selected for the gut longitudinally. With through-and-through sutures unite theedges of the portion of bladder-wall attached to the ureters to the edges of thewound in the sigmoid (Figs. 839 and 840). Cover this line of suture by a lineof continuous Lembert sutures. The result is that the remnant or ellipse of
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