Treatise on gynæcology : medical and surgical . nned. It is doubtfulwhether a urethrocele, by continuing to dilate, can ever pass into thebladder and become a cystocele. Treatment,—The prophylaxis of prolapse of the genital organsconsists in the careful conduct of labor and subsequent rigid observ-ance of hygienic laws. Belts and pessaries give little help; yet wemust not neglect to support the abdomen by a well-constructed band-age which will keep the intestines from bearing down with their fullweight upon the pelvic organs. Pessaries are of use only when the perineum has preserved a de-gree
Treatise on gynæcology : medical and surgical . nned. It is doubtfulwhether a urethrocele, by continuing to dilate, can ever pass into thebladder and become a cystocele. Treatment,—The prophylaxis of prolapse of the genital organsconsists in the careful conduct of labor and subsequent rigid observ-ance of hygienic laws. Belts and pessaries give little help; yet wemust not neglect to support the abdomen by a well-constructed band-age which will keep the intestines from bearing down with their fullweight upon the pelvic organs. Pessaries are of use only when the perineum has preserved a de-gree of tonicity; their action is often aided by a perineal pad (Figs. 494 CLINICAL AND OPERATIVE GYNAECOLOGY. 269 and 270). Breisky23 claims good results from an egg-shaped pes-sary which is held sufficiently in place by the narrow vaginae of agedwomen. Dumontpalliers ring pessary, Hodges pessary, Schultzessled-runner pessary, the giinblette pessary, Gariels air pessary,should all be given a trial. Zwanck-Schillings winged pessary is well <S^. Fig. 269.—Perineal Air-Cushion. known, but of little value [and so dangerous that it should be men-tioned only that it may be avoided]. In order that any kind of pessary be of use, I repeat that a cer-tain degree of tonicity in the perineum is essential, and a somewhatsmall vulvar opening. They are valuable in cases of cystocele, butfail when the uterus takes part in the prolapse. In any case, theyshould never be used except as a palliative measure, trusting to aradical operation for cure. Nevertheless if the rjatient positively refuses surgical aid, or if itoffer but small chance of relief, as in the case of complete prolapse in
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