Operative gynecology : . istence, and underthese circumstances there is no reason why the fistula accidentally discovered should be operated upon. I have seen but two cases, both resultingfrom the traumatisms of labor. In one therewas an elliptical opening in the floor of theurethra at about the middle, cm. long by3 mm. wide, and in the other a round openingabout 4 mm. in diameter, just in front of theneck of the bladder, while just behind the neckthere was a vesico-vaginal fistula a little largerin diameter. The treatment of a simple fistula whichdoes not involve more than one-third of th
Operative gynecology : . istence, and underthese circumstances there is no reason why the fistula accidentally discovered should be operated upon. I have seen but two cases, both resultingfrom the traumatisms of labor. In one therewas an elliptical opening in the floor of theurethra at about the middle, cm. long by3 mm. wide, and in the other a round openingabout 4 mm. in diameter, just in front of theneck of the bladder, while just behind the neckthere was a vesico-vaginal fistula a little largerin diameter. The treatment of a simple fistula whichdoes not involve more than one-third of thelumen of the urethra is like that of vesico-vaginal fistula, by a funnel-shaped denudationof its margins, broad on the vaginal surface,and reaching up to, but not including the ure-thral mucosa. Fine silkworm gut sutures arethen passed transversely, and tied so as tobring the edges into exact apposition. It isbetter to leave a catheter in the bladder forfive days. The stitches should be removed infrom seven to ten Fig. 238.—The Method of introdu-cing the Sutures in the Case ofVesico-vaginal Fistula (B), andUrethro-vaginal Fistula (U). The bridge of tissue between U andB is the neck of the bladder. FOREIGN BODIES IN THE URETHRA. 381 In a case in which a urethral fistula just below the sphincter was compli-cated by a vesical fistula just above it, leaving intact the vesical sphincterring at the internal urethral orifice, the problem was to save this importantbridge of tissue with the hope of retaining its sphincter action. The bridgewas so narrow that both sides of it could not be denuded and sutures passed,so the plan was adopted of denuding the margins of both vesical and urethralfistuhr, treating them as if they constituted one large fistula instead of twosmall ones; the urethral sphincter lying between them was not touched. Thedenudation was made down to the vesical and urethral mucosa3, and extendedout broadly on to the vaginal mucosa; interrupted sutures of silkwo
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