The Abdomen 227 



the ascent of bacteria is, to some extent, prevented. Of late Barbat 

 has endeavored experimentally, with fair success, to use a portion 

 of small intestine to bridge over the gap left after resection of the 

 ureter. This he did by excising a small tract of ileum, without 

 disturbing its mesenteric attachment, closing the two ends of the 

 same, re-establishing the caliber of the remaining intestine with a 

 Murphy button, and implanting the upper end of the ureter and the 

 bladder in the isolated portion. « 



URETEROLITHOTOMY. 



The obstructing calculus being located, the wall of the ureter 

 is incised and the body extracted. The opening is then closed with 

 a few interrupted black silk sutures placed so as not to include the 

 mucosa. The wall of the tube being considerably hypertrophied 

 at this point, is rendered quite prominent. 



URETERO-URETERAL ANASTOMOSIS. 



URETEROURETEROSTOMY. 



Kelly's method is as follows : The open end of the lower frag- 

 ment of the ureter is closed with a fine silk ligature, and just be- 

 neath, a slit, about half an inch in length, is made in the ventral 

 wall. Two black silk sutures are passed through each lateral 

 wall of the lower extremity of the upper fragment, through the 

 slit in the lower fragment and out through its lateral wall. These 

 two sutures serve as tractors by which the upper fragment is drawn 

 into the lumen of the lower through the slit. These sutures are 

 then tied and the slit is entirely occluded. Two additional sutures 

 are passed through the lateral walls, avoiding the mucosa, where 

 the ends overlap. The ureter, thus anastomosed, is dropped back 

 into its normal position. 



URETEROVESICAL ANASTOMOSIS. 



URETERO-CYSTOSTOMY. 



The technic of this operation as experimentally performed by 

 myself, is as follows: The ureter (D) being exposed by raising 

 the bladder, a traction suture (A) is passed through it immediately 

 above the spot at which it is to be divided, and it is stripped of its 



