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again ascertain the lower border of the blad- der bv passing a sound into it, so as to avoid cutting into this important structure. The bladder is now gently pushed up silagra tablets from the cervix and wall of the uterus with the pal- mar surface of the index linger, as is done in vaginal hysterectomy. In some cases, to fabuy silagra can be retained by a vaginal depressor if necessary, a free cav- ity known as the silagra 50 mg vesico- uterine space and the denuded cervix {vide Fig. 4). In the majority of cases of retroversio-flexions there is a prolapsus of the anterior vaginal wall. Even when there is no prolapsus, there is usually relaxation to a lesser or greater degree. Conse(juently, in nearly all cases an an- ■p; Fill. I.' I. iIm' liluililir iiiiitlMiI up ; 'i. vi-Hlcoiilcrliic Hpuci' ; H, di iicil iirvLx. (WIlll.T.) of silagra 50 the liladdiT from llir ulcriiH and not to worry wlii'llicr the piTitoiii'al (liipliciitioiiH (the vcHico-uli'riMc fold) piiss- itiK over the luisc of the iiliiddcr lo tlic milcrior surfiiro of llir iitiTiiH 111' lorn lliroiiirli <.r nol. I ricvrr pjiv iiiiv iilteii- Flti. 5. — Author's sound. terior eolporrhaphy is indicated. In vagino-fixation this serves two purposes : (1) To purchase silagra restore the width of the canal to its original dimensions. (2) Til form a better fixed point for the fixation of the uterus. The colporrhapliy is now easily carried out by resect- ing a corresponding strip of tissue from either vaginal The next silagra online step of the operation consists in anteverting the uterus with a properly constructed sound (Fig. 5) so that its body presents in the vaginal wound. It is of im- ( portance to have the right kind of a sound. I have known operators use a large steel prostatic sound, and they have either failed to antevert the uterus or have forced the point of the instrument through the uterine wall, and were ( compelled to do a ca^liotomy. In some cases the uterus is readily antevcrted, in others again considerable difficulty is experienced, owing to the small arc through which the : sound can pass on account of a high and rigid perinwum. ( Hence the value of the curve buy silagra uk at the lower end of the sound. In virgins and nullipara' it might be necessary to incise the periuanuu so as to gain more room, but I have never had to resort to this, although I have done the oper- j ation in a virgin with a very small vagina and in several luillipane with narrow introituses and rigid perinea. In a few of these cases I have had to resort to passing a few provisional sutures through the uterine cheap silagra wall just above the internal os, and by traction on these cheapest silagra forward and down- ward have aided in anteverting the uterus. Having got the uterus well forward and silagra cipla jireseuting in the silagra 100 mg vaginal inci- sion we next proceed to suture it to the vaginal wall. With a moderately stout cnrMil needle a silk suture is passed lliniu-li the left vai;inai ll.ip at the extreme up|)er I'lid of llic iiicisiiin — iIkiI order silagra i.-;, fiiim cpiic In two centinu'tres lielow (lie nrelliral opening and .■iImhiI half ji silagra tablet i-cnlinu'tri' buy cheap silagra from the edge of generic silagra the tiap. The sutiirr buy silagra online is then .■.■in i.'d silagra price through the anterior wall of the uterus, as nr.ii- I lie fiiinliis as it is jiossilile, ami out Ihrougli the right llap ,it a corn'. Hponding point to that of the opposite sidr. .\ siicnid Hiilure is passed in llic same way about a (■cntiinclri' lulnw the lirst. The sutures are now lied and llie vagiii.il wound is ehmed liy a conlinuons order silagra online catgut suture, (he last one or Oct. 27. 1894.] VIXEBERG: TECHXIQUE AXD IXDICATIOXS silagra uk OF VAGIXO-FIXATIOX.

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