[Reprinted from the American Gynecological And Obstetrical Journal 
for December, 1895.] 
PLASTIC OPERATIONS FOR THE CURE OF FISTULAS 
INTO THE VAGINA FROM THE BLADDER AND 
RECTUM. REPORT OF A CASE OF ELEVEN YEARS' 
STANDING. 
T. A. Stoddard, M. D., 
Gynecologist to the Woman's Hospital, Pueblo, Colorado. 
Mrs. R. came to me in March, 1895, with the following brief his- 
tory • Eleven years ago, as a result of a protracted labor, sloughing 
took place, so that since that time she has been totally unable to con- 
trol the action of her bowels or bladder. During the intervening 
years she had been operated upon seven times, by Dr. W. P. King 
and others of Kansas City, without any good results. 
On examination, I found that the whole base of the bladder had 
sloughed away, as well as every vestige of urethra-in fact, there was 
little tissue covering the posterior surface of the pubes except perios- 
teum. The fistulous opening into the bowel was large-about two 
and a half by one and a half inches. 
On April 16th I placed the patient in Sims' position under chloro- 
form anaesthesia, repaired the recto-vaginal fistula and attempted to 
make a new urethra. I used silver-wire sutures and removed them 
in ten days with perfect results as regards the fistula, but my attempt 
at manufacturing a urethra was a failure. 
One month later I again chloroformed the patient and proceeded 
to repair the bladder I began by separating the tissues from the 
anterior and lateral surfaces of the uterus and succeeded in obtaining 
sufficient tissue to accomplish my purpose. I then vivified the 
edges and brought them together with silver-wire sutures, at the same 
time taking care to leave a space undenuded at the anatomical site of 
the old urethra. This opening I intentionally left sufficiently large 
to allow for contraction afterward. I now dissected a flap from the 
cervix, running spirally almost around it so as to give me a length of 
nearly an inch and a half, and this flap, after denuding in the track of 
the old urethra, I stitched in place with silkworm gut. In denuding 
for the attachment of the flap I dissected up two strips of tissue, each 
Copyright, 1895, by J. D. Emmet, M. D 2 
T. A. Stoddard, M. D. 
about a quarter of an inch wide and about three eighths of an inch 
apart, on each side of the center line. The sutures in the repair of 
bladder 
I'lz 
2H1 
N A 
Fig. I.-Vertical section showing relative position of recto-vaginal and vesico- 
vaginal fistulae. 
UTERUS 
BLADDER 
Fig. 2.-Sketch of uterus, etc., showing spiral incisions made for obtaining flap in 
repair of urethra. Plastic Operations for the Cure of Fistuloe. 
3 
the bladder I passed antero-posteriorly and thus brought the cervix 
close to the original site of the neck of the bladder. When the opera- 
tion was completed I placed a piece of glass tubing through the new 
urethra into the bladder, so as to afford free egress for the urine. 
This tube I kept in place constantly for fifteen days, only removing 
it once in three days to cleanse it. The stitches I removed in twelve 
days and found that part of the flap had sloughed away, but still 
Fig. 3.-Sketch plan of vagina, showing vesico-vaginal fistula, with sutures in posi- 
tion ; also spiral flap suspended from the cervix of uterus, afterward placed so 
as to form urethra. 
there was enough to render good service. The patient can at this 
writing retain her urine for three and a half hours and then get over 
a vessel and void it naturally. She has no trouble with her bowels, 
and is really a sound woman, after being in this condition (a living 
death) for eleven years. Drs. Willard, Black, Paul, Woods, Rice, 
and others assisted me, and the operation was done in the Woman's 
Hospital in this city.