Transactions of the Section on Obstetrics and Diseases of Women of the American Medical Association (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1907 Excerpt: ...the vaginal wall may be closed over it; otherwise it is best to drain. If it is impossible to sew the edges of the incision in the ureter it will have to be left alone. Some operators have advised passing a catheter through the bladder into the ureter up beyond the incised portion and allowing it to remain for a time. This does not seem necessary if the urine is not infected and the incision is a clean one; if, however, there is periu reteritis with dense inflammatory tissue around the ureter it may be well to pass the catheter as first advised by Albarran,24 and later by Kelly.25 If preferred, a stylet may first be ruu up into the ureter, over which a catheter tube is slipped; the open hole at the kidney end collects the urine better than a catheter with a hole in its side. Kelly,26 operating extraperitoneally on an adult female, with stone impacted just behind the broad ligament, was unable to safely remove it owing to dense adhesions. He, therefore, displaced it by thrusting it forward until it could be felt through the vault of the vagina. A small incision in the vaginal vault safely removed it. If the stone is soft and can be easily crushed with the fingers, this may be tried, though without much hope of success. If it crushes easily it may pass per vias naturales. Young27 refers to some of Rovsing's cases in which this method was used. Stones impacted near the ureteral orifice in the bladder which can not be removed by incision of the ureter through a cystoscope may be approached, as shown by Kelly,28 through a vesicovaginal incision. The patient is placed in the knee-chest position, the bladder distended with air, a rapid cut made through the septum, which exposes the field, and the stone is easily picked out of its bed. Doyen's29 operation consists ...