[Reprinted from The Medical News, August 17, 1895.] 
V ESICO-VAGINAL FI ST U L A - SUT U R E OF 
BLADDER WITH CATGUT. 
By J. J. BROWNSON, M.D., 
OF DUBUQUE, TKWX?™ 
Mrs. D. L. F., aged thirty-two years, the mother of 
four children, came under my care to be operated upon 
for a vesico-vaginal fistula. Her history was good, with 
the exception of some difficulty in micturition during 
childhood, the precise nature of which I was unable to 
learn. The story of the case as narrated by the patient 
is as follows : About two years ago she lived upon a farm 
in Minnesota, and her home was about ten miles from 
the nearest village. While residing at that place she 
was confined with her fourth child. The labor passed 
all right, but she had retention of urine following it. 
The physician in attendance, after visiting her for several 
days for the purpose of using the catheter, said that he 
would be unable to attend her any longer, and, as she 
would not or could not use the instrument herself, he 
made an opening from the vagina into the bladder 
through which the urine drained away. 
The constant annoyance of the infirmity caused the 
woman to seek relief. Accordingly she was sent to the 
Mercy Hospital in this city to be prepared for operation. 
Upon examination the urethra was found patulous 
and seemed natural. There was a fistula about three- 
fourths of an inch long in the vesico-vaginal septum. 
The uterus and vagina were otherwise normal. 
The patient was taken to the operating-room, and, 
with the assistance of Drs. Boothby, McCarthy, and A. 2 
Staples, steps were taken to close the opening. The 
woman was placed in the usual position and a sound 
passed into the bladder up to the fistula to serve as a 
guide, while the tissues of the vagina and bladder were 
pared funnel-shaped so as to make a good-sized denuded 
surface on the vaginal side. When all was prepared it 
occurred to me that it would be a good idea to unite the 
mucous membrane of the bladder with catgut, and 
this was done by means of a continuous suture. The 
tissues of the vagina were then sutured together with 
four silver wires. Having no sigmoid catheter a soft- 
rubber one was fastened in the bladder, and the vagina 
was packed with iodoform-gauze. 
The after-treatment of the case progressed favorably 
until the third night, when the catheter slipped out. On 
the next morning a pint of urine was drawn off and 
the catheter reinserted; but it did not stay in well; so 
after the first week the retention of the instrument was 
abandoned altogether and the water drawn twice a day. 
On the eighth day the urine was tinged with blood and 
remained so for two days. I was unable to account for 
this unless it was from the disintegration of the catgut 
stitches. 
Nothing unusual presented itself from this time on. 
At the end of the third week the silver wires were re- 
moved. The wound had healed solidly. Not a drop 
of urine had escaped. In fact, after the stitches were re- 
moved it was difficult to see the exact site of the closure. 
The patient was at this time requested to urinate in 
the natural way, but she maintained that she could not. 
The catheter was accordingly passed for one week 
longer, when, as the woman again refused to attempt to 
micturate, a large glass dilator was introduced into the 
urethra and allowed to remain for several minutes. 
Following this she was able to pass water, and has not 
complained of any trouble since. She is at present in 
good health, and, as it is several years since the opera- 3 
tion was performed, the relief may be considered as per- 
manent. 
Of course, one cannot form conclusions from one 
case, but I think the suture of the bladder with catgut 
is a good feature, for the reason that it forms a double 
joint, preventing leakage of urine, and thus giving the 
vaginal tissues opportunity for union, while the possible 
objection, that should any of the catgut remain unab- 
sorbed a calculus might result, would not seem war- 
ranted by the outcome of this case.