Treatise on gynaecology : medical and surgical . ral traction uponthe urethra, and bend it so as to diminish the patency of the method is as follows: Seizing the urethra with a tenaculum, hedisplaces it as far as possible to either side, marking the points whichcorrespond to this displacement (Fig. 100). Having outlined his de-nudation he proceeds to make two parallel incisions between thepoints. The orifice is then drawn with a hook toward the clitoris, CICATSICIAL FISTUL^E OF THE VAGINA. 33a and the point marked to which it can be displaced. The incision isthen carried forward, tak
Treatise on gynaecology : medical and surgical . ral traction uponthe urethra, and bend it so as to diminish the patency of the method is as follows: Seizing the urethra with a tenaculum, hedisplaces it as far as possible to either side, marking the points whichcorrespond to this displacement (Fig. 100). Having outlined his de-nudation he proceeds to make two parallel incisions between thepoints. The orifice is then drawn with a hook toward the clitoris, CICATSICIAL FISTUL^E OF THE VAGINA. 33a and the point marked to which it can be displaced. The incision isthen carried forward, taking care to give it a slightly concave shapeinteriorly, so that after the suture the external urethral orifice shallnot be too constricted. Having comx3leted the outline, denudation isdone and tissue removed at the side of the urethra so as to give asomewhat deep wound; the sutures are then placed drawing theurethra toward the clitoris, the sutures being directed obliquely asthey approach the urethral orifice, and at the posterior portion being. AIII IV Fig. 100.—Pawliks Operation for Diminishing the Calibre of the Urethra. I., Urethral regionas seen when the patient is in the genu-pectoral position ; II., extent of the denudation to be made, esti-mated by traction with a hook ; III., denudation ; IV., result obtained. A, Pubic arch ; C, projection ofurethral canal; D, posterior depression of the pubis ; U, meatus urluarius ; a, b, c, a, b, c, outlines ofthe juxta-urethral denudation. inserted antero-posteriorly. Pawlik operates in the genu-pectoralposition, and uses carbolized silk, powdering the line of his sutureswith iodoform. He does the second operation upon the other sideafter cicatrization of the first, and recommends frequent emx)tying ofthe bladder. He has obtained several good results by this method. Fecal Fistul^e.—I include under this common title both recto-and entero-vaginal fistulse. 334 CLIIS^ICAL AND OPEPvATIYE GYNECOLOGY. Hecto-vaginal Fistula : Etiology.
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