A treatise on the medical and surgical diseases of women, with their homopathic treatment .. . la into the vagina, making it neces-sary to modify the steps of the operation somewhat from thatjust described in the treatment of vesico-vaginal the parts are more easily reached than where the fistula is situated higher up in thevagina, and consequently the pro-lapsed tissue can be more readilyreplaced than it could be if it oc-curred in vesico-vaginal fistula. The patient should be preparedfor the operation the same as invesico-vaginal fistula. The prepa-ration of the clothing,
A treatise on the medical and surgical diseases of women, with their homopathic treatment .. . la into the vagina, making it neces-sary to modify the steps of the operation somewhat from thatjust described in the treatment of vesico-vaginal the parts are more easily reached than where the fistula is situated higher up in thevagina, and consequently the pro-lapsed tissue can be more readilyreplaced than it could be if it oc-curred in vesico-vaginal fistula. The patient should be preparedfor the operation the same as invesico-vaginal fistula. The prepa-ration of the clothing, table, and in-struments about the same. A goodsized sound should be introducedinto the bladder through the urethraand held by an assistant; or a ca-theter may be used in place of thesound, which saves the necessityfor the removal of the sound andthe introduction of the catheter afterthe completion of the operation,which is certainly some advantage. If the case is a recentone, and the vaginal edge of the fistula has granulating sur-faces, we at once proceed to stitch them together with the. Fig, No. 55. VAGINAL FISTULjE. 527 silver wire, using the semi-circular vesico-vaginal needle tocarry it. Care must be taken in placing the sutures, thatwe turn back into the urethra the redundancy of tissue whichprotrudes through the fistula; for,should we cut it away, we woulddeprive the patient of retentivepower in the bladder, as it is thisredundancy of tissue, which servesin place of a true sphincter muscleat the neck of the bladder; and be-sides the cutting away of this ap-parent excess of tissue would verylikely cause alarming hemorrhage. There is, perhaps, more skill re-quired in the placing of the suturesin urethrovaginal fistula than incases of vesico-vaginal fistula. Theneedle must be inserted, so thatwhen the suture is tightened theprotruding tissues are turned backinto the urethra, and the vaginalmembrane is brought together over them. Either the straightor my curved needle hold
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