Gynecological diagnosis . ingfrom them is noted. It is never justifiable to pass a ureteral catheterinto a presumably healthy ureter in the presence of acute or sub-acute cystitis, until the nature of the infection in the bladder isknown, because of the great danger of carrying infection into theureter, and until all other attainable facts as to the existence ofkidney disease are in hand the physician should be content notto invade the ureters. In the presence of infection the bladdershould be irrigated with sterile one-per-cent boric acid solutionbefore ureteral catheters are passed and such
Gynecological diagnosis . ingfrom them is noted. It is never justifiable to pass a ureteral catheterinto a presumably healthy ureter in the presence of acute or sub-acute cystitis, until the nature of the infection in the bladder isknown, because of the great danger of carrying infection into theureter, and until all other attainable facts as to the existence ofkidney disease are in hand the physician should be content notto invade the ureters. In the presence of infection the bladdershould be irrigated with sterile one-per-cent boric acid solutionbefore ureteral catheters are passed and such an irrigation shouldbe the last step in the cystoscopy. 474 DISEASES OF THE BLADDER VARIX OF THE BLADDER Varicose veins of the bladder is a very rare condition, althoughfrom a priori considerations it should be common. It has beenfound in men associated with rectal hemorrhoids. Knorr showsin his book a beautiful plate of a varix in the neighborhood of theright ureteral orifice as seen through the electric cystoscope. Hem-. Fig. 188.—Varix of the Bladder near the Opening of the Right Ureter. (Knorr.) orrhage from the bladder is the chief symptom, and difficulty ofurination may be present. Cystoscopy affords the only opportunityfor an exact diagnosis. FISTULA OF THE BLADDER A vesical fistula is an abnormal channel of communicationbetween the bladder and an adjacent organ. Fistulse are of threesorts:—1. Vesico-vaginal, 2. vesico-uterine, 3. vesico-intestinal andother fistula?. 1. Ves ico-Vaginal Fistula Frequency, Etiology, and Pathology.—Vesico-vaginal fistulse varyin size from a pin-point opening to a large hole involving theentire base of the bladder. The cervix may be involved, in which FISTULA OF THE BLADDER 475 case the fistula becomes vesico-uterine as well as opening is generally situated in the median line in the case of afistula involving the cervix as well as the vagina, according toThomas Addis Emmet (Vesica-Vaginal Fistula/ 1868). Inother fist
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