. Operative gynecology. st, the elasticityof the catheter tends to pushthe ureter out close to thepelvic wall, out of the wayof the operation, and second,by means of the catheter, theureter is converted into ahard cord which can be feltat all times during the enu-cleation, so insuring its safe-ty from injury. The best plan is to intro-duce the catheters before giv-ing the patient the anesthetic,so as to shorten the time ofthe anesthesia and to avoid theadditional shock incident to placing her in the knee-breast position and catheter-izing while under the anesthetic. I have several times cathet
. Operative gynecology. st, the elasticityof the catheter tends to pushthe ureter out close to thepelvic wall, out of the wayof the operation, and second,by means of the catheter, theureter is converted into ahard cord which can be feltat all times during the enu-cleation, so insuring its safe-ty from injury. The best plan is to intro-duce the catheters before giv-ing the patient the anesthetic,so as to shorten the time ofthe anesthesia and to avoid theadditional shock incident to placing her in the knee-breast position and catheter-izing while under the anesthetic. I have several times catheterized the uretersbefore doing a hysterectomy, ^vithout elevating the pelvis at all, by simplydirecting the speculum down to that part of the bladder where the ureteral ori-fices would naturally be looked for, and sliding it over the mucous surface untilfirst one orifice is seen and catheterized ; then the speculum was withdrawn andre-inserted beside the catheter, and the opposite orifice was sought out Fig. 465.—The Kelat Utekl D Bladder to the The right ureter is seen crossing under the uterine artery at alittle distance from the cervi.\- and entering the collapsed bladderin front. The uterus is above and to the left. The lower part ofthe figure is made up of vagina on the left and urethra on theright, with a slight sulcus between. 324 ABDOMINAL HYSTERECTOMY FOR CARCINOMA OF THE UTERUS. When the broad ligaments are much involved it will sometimes be found im-possible to pass the end of the catheter more than 3 or 4 centimeters into theureter. This would seem to be due to the fact that one of the prime conditionsnecessary to the passage of the catheter is a certain amount of mobility on thepart of the ureter, and when this is impaired by fixation in an inflammatory massthe end of the catheter butts up against the mass and is unable to turn the sharp angle formed and so to find thelumen. This condition is diagram-matically represented in Fig. 466. The closur
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Keywords: ., bookcentury1800, bookdecade1890, booksubjectgenitaldiseasesfemal
