Identifier: americangynaecol1518unse (find matches)
Title: American gynaecological and obstetrical journal.
Year: 1899 (1890s)
Authors:
Subjects: Obstetrics Gynecology
Publisher: New York : D. Appleton & Co.
Contributing Library: Columbia University Libraries
Digitizing Sponsor: National Endowment for the Humanities (NEH)

View Book Page: Book Viewer
About This Book: Catalog Entry
View All Images: All Images From Book
Click here to view book online to see this illustration in context in a browseable online version of this book.

Text Appearing Before Image:
). Butthis method, if used exclusively, gave no promise of obviating futuretrouble in our case. 414 Emil Ries, M.D. In order to prevent the recurrence of the incontinence after the pa-tient had returned home it seemed advisable to get the urethra out of theway by placing the meatus externus at a point where it would be lessexposed. The operations of Schroeder (Moericke, Zeitschrift fur Ge-burtshiilfe, vol. 5), of Pawlik (Wiener medisinische Wochenschrift,1883) and of Himmelfarb (Archiv fur Gyndkologie, 1893) have thecommon principle of advancing the urethra, giving it at the same timea kink around the pubic arch, and pressing the posterior wall of theurethra against the anterior wall. In Schroeders operation the lateraledges of the meatus externus are sutured to corresponding roundedsurfaces higher up towards the clitoris. Pawliks operation is similar.But these operations afford very small wound surfaces for suturingand the risk of failure is thereby enhanced considerably. Pawlik him-
Text Appearing After Image:
3t$.* *jf-3 self has had failures, Schroeders operation is not much different fromhis and Himmelfarbs case had to undergo five operations before it wascured. The principle of these operations, however, seemed useful in ourcase with special reference to prevention of recurrence and so I decidedupon a combination of principles and performed an operation, themechanics of which united Gersunys twist with the kink, the constric-tion and the advancement of the urethra. I placed a silkworm suture on the lower circumference of theurethra in the median line as a guide for the twist (S), then I made an Incontinence of Urine: Report of a Peculiar Case. 415 incision around the meatus externus (E M. Fig. 1) and continued thisinto an incision in the median line along the anterior vaginal wall about5 cm. long. I dissected back the vaginal flaps (a and b. Fig. 1 and 2.)and continued the dissection of the urethra (U. Fig. 2) until I had laidbare the urethra all around to the distance of about four cm.

Note About Images