Secondary sequelae after interposition of the uterus

Abstract

Between the years 1914 and 1918, in a special clinic for cystoscopy of the female, some forty patients with bladder complaints, who had been subjected to interposition operations by others, came under observation. At that time the indications for the operation were not clearly defined and the technic had not been perfected. Occasional instances of unsatisfactory results encountered thereafter, as well as the recollection of the first group of cases, discouraged the use of this operation for several years, until a careful consideration of the technical details convinced me that the undesirable sequelae could be eliminated. Mackenrodt, Dührssen, Watkins, Wertheim, Schauta, and others have contributed to the present-day technic, which probably varies somewhat in different clinics. For the past ten years I have done the operation in selected cases of procidentia and large cystocele with considerable satisfaction and without the embarrassment of subsequent therapeutic problems. This has been due to restricting its application absolutely to women past the menopause, as well as to a proper regard for certain precautions which suggested themselves, as the causes of unpleasant end-results were analyzed. The purpose of this discussion is to crystallize the causative factors of surgical disappointments rather than to submit statistics on personal operative successes, which will be reviewed in a subsequent communication.