Identifier: diseasesofkidney01kell (find matches)
Title: Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women
Year: 1922 (1920s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943 Brödel, Max, 1870-1941 Burnam, Curtis Field, 1877-
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Publisher: New York, London : D. Appleton and company

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h urethral exam-ination is an indispensa-ble preliminary to the ex-amination of the upperurinary tract. As a rou-tine we introduce into thebladder a Kelly speculum,No. 10 (Fig. 117), and,while slowly withdrawingit, study the mucous mem-brane all the way from the bladder end to the outside. As the speculumleaves the bladder the sphincter urethra* begins to close down. The gradualwithdrawal brings the opening in the bladder to a pin point and finally itdisappears. The picture is that of a flat funnel, the apex of which is the central fig-ure. This central figure forms a large free opening at the internal ureteralorifice. As the speculum is withdrawn it becomes quadrilateral or oval, andin the middle of the urethra forms a transverse line, while at the exterior theline becomes vertical. The walls of the funnel are made up of radiating foldsof mucous membrane which converge on the central figure. The posterior foldis a continuation of the triangular elevation on the trigonum, and has been
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Fig. 121.—Knee-breast Posture, Speculum Intro-duced. Note degree of separation of legs. Thiswill vary with individual case. 248 EXAMINATION OF THE URINARY TRACT IN AVOMEN. called by J. C. L. Barkow the eolliculus cervicalis. ISTumerous delicate bloodvessels are seen in the mucous membrane of the viretbra. The orifices of the nretliral glands appear as fine points, often in groupslineally disposed. They can be best brought in view by directing the speculumaway from the central figure directly on to them. The average adult femaleurethra measures 3 cm. in length. It varies from 2 cm. to 5 cm. The caliberis such that without dilatation one can readily use a !No. 10 speculum. Bydilatation this can be greatly increased, and, under anesthesia, it is possible touse a No. 12 or No. 13 without rupture of the sphincter. Bladder Inspection.—The direct examination of the bladder is the most im-portant and the most satisfactory of all methods of investigation of the urinarytract. By this means

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