Gynecology . on from stone, opening of the bladder and drainage throughthe vagina gives immense relief. Dudleys technic in performing this operationis first to distend the bladder with water, the patient being under general anes-thesia in the dorsal position. A pair of curved artery forceps is introducedinto the bladder and the ends separated. An incision is then made betweenthem into the bladder (Fig. 411), care being taken not to cut the structures atthe neck of the bladder. The incision is f to 1 inch long and should be large 703 704 GYNECOLOGY enough to insure competent drainage. There nee
Gynecology . on from stone, opening of the bladder and drainage throughthe vagina gives immense relief. Dudleys technic in performing this operationis first to distend the bladder with water, the patient being under general anes-thesia in the dorsal position. A pair of curved artery forceps is introducedinto the bladder and the ends separated. An incision is then made betweenthem into the bladder (Fig. 411), care being taken not to cut the structures atthe neck of the bladder. The incision is f to 1 inch long and should be large 703 704 GYNECOLOGY enough to insure competent drainage. There need be no fear that there willbe later trouble in closing the fistula. The chief difficulty is in keeping thesefistulas open, and for that reason the additional precaution must be takenafter making the incision of sewing the bladder mucosa to the vaginal mu-cous membrane. If, after the lapse of time, it becomes desirable to close thewound, and it is still open, an ordinary vesicovaginal operation is practically. Fig. 411.—Vaginal pair of half-length curved clamps is introduced into the bladder through the urethra andpartly opened. An incision is made through the vaginal and bladder walls between the ends of theclamps (adapted from Kelly and Burnam). sure to be successful. In this case the conditions differ from the fistulas thatfollow childbirth in which the vesicovaginal septum has suffered a loss of tissue,so that the operation of closure is hampered by the tension of the wound nullipara, in whom the perineum acts as an obstruction to full drainage,Kelly recommends enlarging the introitus by incising the peritoneum andsewing the vaginal mucous membrane to the skin transversely, as in Fig. 240. OPERATIONS ON THE RECTUM PROLAPSE OF THE RECTUM The treatment of prolapse of the rectum depends on whether the conditionis one merely of prolapse of the mucous membrane, such as is frequently seen inchildren, or whether it is a so-called true prolapse in which all
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