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The external genitals should then carefully palpated and the existence of any hard resisting body carefully searched for in the labia majora, since they might testicles or ovaries.

This necessary, since in childhood are not aided the presence menstruation or the female habitus. In the above-mentioned case Debout, there was a hernia A persistent uro-genital sinus may mistaken for atresia hymenis, and acquired atresia vulvae. In either case conjoined vesical and rectal examination will inform whether there a tumor or only a thin membranous septum between the two organs. If with finger, sound, or catheter, two openings can demonstrated, the diagnosis not difficult. If the entrance the sinus uro-genitalis very narrow, rapid dilatation with Simon's urethral specula may tried, and an ocular examination made for another opening. Finally the secretion must examined chemically for urea, and microscopically for pavement and cylindrical Treatment.

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This may palliative or radical. When there complete absence the urethra, and the finding a ghostwriter bladder opens into the vagina a fissure and also when the urethra partially developed and the sinus uro-genitalis persists, the construction an artificial urinal canal might attempted. From either side the vagina, a flap about half an inch broad stripped the symphysis, and, with its mucous surface turned in, united above the pared margins the vesical cleft, and at the middle united its fellow the opposite side. Heppner considers the operation difficult, but possible. It doubtful, thesis formatting however, whether the possession a urethra devoid muscular fibres and incapable voluntary contraction, would better the patient's condition.

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Nevertheless, the formation the new channel would prevent the urine flowing into the vagina, and would facilitate retention and the application a suitable receptacle. Lebedeff has successfully performed On the other hand Heppner suggests the formation an artificial urethra means a trocar-puncture into the bladder, and the subsequent closure the fissure suture.

There great danger this proceeding wounding important vessels, and the unavoidable contraction of the opening will cause retention, a far worse evil than incontinence of urine.

Heppner disapproves an operative reduction the vesical fissure the size the normal urethra, since the anterior wall the slit contains very probably no muscular structure, and academic paper writers our experience with patients with fistula teaches that linear slits, even when large calibre, retain urine better than small circular openings. His patient suffered only from incontinence at night caused her wear a bandage similar the one Sawostitzki recommends. It consisted an abdominal band, which was attached a spring bearing an olive-sized pad. The pad, introduced into the vagina, compressed the posterior edge the fissure against the symphysis fulfilled its purpose perfectly, and the patient soon became accustomed Schatz's incontinence-pessaries might also use in these cases.

Operative procedure course our only resource in atresia urethra?. Cabral operated a servant at Beaucaire, who had had atresia from birth, and in whom tire urine issued from a cocks-comb-like growth at the navel some two inches long, causing a frightful smell. He perforated in the region the urethra, and tied the growths that they dropped off in twelve days. Middleton had a girl seven days old who had never urinated, and whose abdomen was enormously swollen. He plunged a trocar in the direction the urethra, cheap paper writing service emptied the bladder, and maintained help with thesis statement the patency the artificial passage. Oberteufer's patient wore a sponge fastened a bandage over the fistula. 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