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The first class may caused perforation with the sound, with the lithotriptor, or other foreign bodies, especially hair-pins. A fall upon a sharp body, as upon the pointed stake a fence, etc. may cause fistula or puncture the bladder in retention help with college essays urine, due, for essay writing services review instance, to retroflexio uteri gravidi, or an accidental wound in vaginal puncture of the ovary may cause It may follow lithotomy. Further, the bladder may injured in amputatio calli uteri, in prolapsus uteri also in ovariotomy, and, as the cases Dieffenbach and Freund teach in the attempt open with the knife an imperforate vagina.

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Mittelhauser claims that the forcible passage a finger help with writing essays into the urethra has caused incontinence. It well known that fissures may caused in this way but that the passage one finger the entire urethra may torn through the bladder, and the bladder wall then also perforated in the same manner, seems almost impossible. For I have essay pay to do paper writing services online often made digital exploration the inner surface buy homework papers the bladder, when the urethra in spite specular dilatation still offered great resistance, and have caused no tear.

Still less likely the occurrence a fistula concubitus violentus, as Munnik has claimed. A blunt body like the male penis can hardly college application essay services tear the walls dilatable a cavity as the bladder, either per vaginam or per urethram, even in the case a rape committed upon a girl six years old, as in Pollak's case.

On the other hand not infrequently observed that large and sharpedged pessaries, or those left too long in situ, have caused perforation of the vesico vaginal septum. The cases Fabricius Hildanus, Breschet, Be-rard, Dupuytren, Dieffenbach, Lisfranc, Busch, and others prove this. Erosions occur in the most tensely stretched portion the vaginal wall, then ulcerations, and finally the pessary breaks through into the bladder, and occasionally into the rectum at the same time. Zwanck's pessaries are especially dangerous in this respect I have seen one and Pagenstecher has seen two cases vesico and recto-vaginal fistula caused them. Ulcerative malignant processes may cause fistula in carcinomatous disease the uterus and the vagina. Statistics show see page that half these patients eventually suffer from perforation the bladder and most frequently the vesico-vaginal wall suffers.

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In hardly, of the cases does the new growth destroy the utero-vesical junction.

It doubted many whether tubercular or syphilitic ulceration can cause urinary fistula. The pulmonary and intestinal complications progress more rapidly than those the urinary organs, and sometimes seem them causing hypertrophy the vesical wall. college essay help online A case Freund teaches that specific vaginal ulcerations may cause urethrovaginal fistula, and one Beckwith's shows that they may cause vesicovaginal fistula. Among the diseases the bladder, which may cause spontaneous vesicovaginal fistula, the most important stone in the bladder. See VI. Others are chronic ulcerative vesical catarrh with diverticulumformation and carcinomatous degeneration beginning in the vesical Finally must remember that disease in the neighborhood the walls the bladder occasionally causes fistula pelvic abscesses may perforate both bladder and vagina hematocele may the same, and also may ovarian abscesses, and those due an extra-uterine pregnane see the Anatomical Relations Urinary Fistula in the Female. We must now more minutely specify the exact scat, size, form, and edges, etc. the abnormal openings which have been considering. We will begin with the seat, upon which often depends the shape.

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