On the other hand Heppner suggests the formation of an artificial ure thra by means of a trocar-puncture into the bladder, and the subsequent closure of the fissure by suture. There is great danger by this proceed ing of wounding important vessels, and the unavoidable contraction of the opening will cause retention, a far worse evil than incontinence of urine. Heppner disapproves of an operative reduction of the vesical fissure to the size of the normal urethra, since the anterior wall of the slit contains very probably no muscular structure, and our experience with patients with fistula teaches us that linear slits, even when of large calibre, retain urine better than do small circular openings. His patient suffered. only from incontinence at night; he caused her to wear a bandage similar to the one Sawostitzki recommends. It consisted of an abdominal band, to which was attached a spring bearing an olive-sized pad. The pad, introduced into the vagina, compressed the posterior edge of the fissure against the symphysis; it fulfilled its purpose perfectly, and the patient soon became accustomed to it. Schatz's incontinence-pessaries might also be of use in these e,ases.
Operative procedure is of course our only resource in atresia urethrte. Cabral operated in 1550 on a servant at Beaucaire, who had had atresia from birth, and in whom the urine issued from a cocks-comb-like growth at the navel some two inches long, causing a frightful smell. He per forated in the region of the urethra, and tied the growths so 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 of the urethra, emptied the bladder, and maintained the patency of the artificial passage. Oberteufer's
patient wore a sponge fastened by a bandage over the fistula. In fact all the apparatuses which we shall describe in connection with urinary fistula, may be used in incontinence.
The abnormalities called epi- and anaspadia in women, are really vesi cal fissures, and will be considered under that head.
Duplexity is a rare developmental anomaly of the female urethra. The single undoubted example of it has been recorded by L. Ffirst.' Furst found in a preparation taken from the body of a virgin female, that the urethra, single at the bladder, at 1 line from it bifurcated, a thin septum running from right to left, dividing the canal. This septum grew thicker as he advanced forward, and the meati were over a line distant one from the other at the vestibulum vaginte. The superior urethra also curved to the right, and the posterior one to the left. The left urethra had a meatus fth inch in diameter exactly in the median vaginal line, while the other meatus only measured ilgth of an inch. The total length of both nrethrie was 1 inch. It is extremely rare for the duplexity of the first allantoic appen.dages to persist in this way, and not to undergo fusion during the various changes the sinus uro-genitalis passes through. Uterus and vagina were normally developed. In 1875 Lewis published a case in which a puerperal woman came under his observation, who besides a normally patent urethra, had one that ended. in a blind sac. She is said to have undergone an operation for retention of urine immediately after birth, and one of these urethra is as probably an artificial product.