Identifier: gynecologygrav2 (find matches)
Title: Gynecology
Year: 1916 (1910s)
Authors: Graves, William Phillips, 1870-1933
Subjects: Gynecology Genital Diseases, Female Women Gynecology
Publisher: Philadelphia and London : Saunders
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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e which serve as aguide to the denudation. These four marks correspond to the points A, B, C, and D in the diagram(Fig. 224). passing across the cystocele, and issuing at F. The ends of the suture are clampedand drawn sharply upward by the assistant. This approximates and bringsinto easy reach the edges E-F and E-D, which are then united by several inter-rupted sutures. OPERATIONS ON THE VAGINA 533 The first stage of the operation is now completed, and should result in reduc-ing the posterior part of the cystocele and drawing a tight bar of tissue acrossthe front of the cervix. The second stage of the operation is directed to theanterior part of the cystocele which includes the urethra. This portion isusually protuberant, though the prominence of the tissue is often due rather tohypertrophy of the vaginal wall than to hernia of the urethra. A point A is selected several centimeters from the urethra, which will,without too great tension, meet the points G and C when brought together in
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Fig. 226.—Operation for Cystocele. (Authors method.)Stitches placed and ready for tying. the middle line. The points H and B are determined by the insertion of thetenacula. The area included between G, H, A, B, and C is then denuded.A crown suture entering near the angle C, including the angle A in the mannerof a mattress suture and issuing at G, is then passed and the ends clamped.By drawing this suture sharply to the left the edges H-G and H-A are ap-proximated and sewed with interrupted sutures, and by drawing the suturesharply to the right the edges A-B and B-C are united in a like manner. The 534 GYNECOLOGY crown suture is then tied, two or three stitches placed between G and F, and theoperation is completed. By carrying out this technic the cystocele is reduced throughout and thewound edges are all accurately approximated.

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