Gynecology . ce, as can be plainly testedby drawing out and again inserting the bent sound. The sutures thus placedare reinforced by two or three other sutures of linen, which pick up firm unyield-ing fibrous tissue well up on the sides of the urethra. The operation for cystocele is then continued in the usual manner, provisionbeing made to give a little extra tightness at the point corresponding to theneck of the bladder. When finished the appearance is like that seen in Fig. 230. 538 GYNECOLOGY EMMETS PERINEOPLASTY. (AUTHORS TECHNIC.) First Step.—The posterior wall of the vagina is grasped w
Gynecology . ce, as can be plainly testedby drawing out and again inserting the bent sound. The sutures thus placedare reinforced by two or three other sutures of linen, which pick up firm unyield-ing fibrous tissue well up on the sides of the urethra. The operation for cystocele is then continued in the usual manner, provisionbeing made to give a little extra tightness at the point corresponding to theneck of the bladder. When finished the appearance is like that seen in Fig. 230. 538 GYNECOLOGY EMMETS PERINEOPLASTY. (AUTHORS TECHNIC.) First Step.—The posterior wall of the vagina is grasped with a pair of Cullenhooks at a point which when approximated to the anterior vaginal wall willtouch it at the junction of the anterior and middle thirds of the urethra. If acystocele has been performed by the method described on page 530 the point willcorrespond to the crown stitch on the anterior wall. A tenaculum is then placedjust inside the opening of the left Bartholins gland and drawn sharply outward,. Fig. 231.—Operation for Laceration of the Perineum. (Emmets method.)Exposure of the lateral sulci and external perineum. Tenacula are placed at the orifices of theducts to Bartholins glands and drawn outward. A tenaculum or bullet forceps seizes a point on theposterior vaginal wall which when approximated to the anterior vaginal wall will touch it at thepoint of junction of the middle and outer thirds of the urethra. In denuding the lateral sulcus atenaculum is placed at the natural angle formed by exposing the sulcus. (See Fig. 232.) while the traction forceps attached to-the posterior wall is drawn in the oppositedirection. This exposes a triangular depressed area or sulcus with the apex insidethe vagina. The size of this area represents the amount of separation of theanterior fibers of the levator ani muscles (puborectalis) from the sides of therectum. In the normal perineum, or one in which there has been no separationof the puborectalis, the triangular sulcus is ei
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