URINARY INCONTINENCE.THE TREATMENT OF CERTAIN FORMS BY THE FORMATION OF A VESICO-VAGINO-RECTAL FISTULA, COMBINED WITH CLOSURE OF THE INTROITUS VAGINÆ.

Abstract

Incontinence of urine in the woman is usually due to a vesico-vaginal fistula. The ordinary varieties of such fistulae are easily cured by plastic surgery if modern methods be employed. Even large fistulae involving a considerable portion of the vesico-vaginal septum and surrounded by dense scar tissue can be successfully closed by loosening the attachments of the bladder, separating this viscus from the vaginal wall and closing the rent in the bladder wall by a separate suture. But there always will remain cases where the neck of the bladder and portions of the urethra have been so destroyed as to preclude the restoration of the sphincter urinae muscle, so that continence will be established. Under such circumstances the surgeon must consider the following procedures: 1. He can construct by a plastic operation an urethra which will serve as a channel for the urine, but leaves the patient without control of