Gynecology . ation is as follows: The anterior vaginalwall is denuded in exactly the same way as in the operation for cystocele de-scribed on page 531. When the denudation has been completed, the urethrais then dissected out with blunt curved dissecting scissors. This leaves the flapsat the upper part of the operative field free. Tenacula are then inserted in thethree converging angles and the flaps drawn sharply outward. In this way the OPERATIONS ON THE VAGINA 537 urethra at its entrance into the bladder and the surrounding tissue are widelyexposed to view (Fig. 229). A uterine sound, with i
Gynecology . ation is as follows: The anterior vaginalwall is denuded in exactly the same way as in the operation for cystocele de-scribed on page 531. When the denudation has been completed, the urethrais then dissected out with blunt curved dissecting scissors. This leaves the flapsat the upper part of the operative field free. Tenacula are then inserted in thethree converging angles and the flaps drawn sharply outward. In this way the OPERATIONS ON THE VAGINA 537 urethra at its entrance into the bladder and the surrounding tissue are widelyexposed to view (Fig. 229). A uterine sound, with its point slightly bent, is nowintroduced into the bladder. As the point of the sound passes the internalorifice of the urethra it gives a slight but very perceptible jump. This pointis readily marked by feeling the end of the sound from the side of the vaginalwound. By pressing backward on the handle of the sound the exact locationof the bladder neck can be kept constantly in view. Several interrupted sutures. £ Gravies- Fig. 230.—Kellys Operation for Incontinence Combined with the Authors Anterior Col- poplasty. Operation Completed. of fine linen are then passed, picking up ragged tissues on each side of the urethraat the level of its entrance into the bladder. These sutures are tied in themiddle line, and serve to compress the internal orifice, 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 approxi
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