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The multicystic dysplastic kidney
LETTERS TO THE EDITOR
Intraprostatic Ethanol Injection Prior to Transurethral Resection of the Prostate for Prevention of Perioperative Blood Loss TO THE EDITOR:
The effectiveness of intracapsular ethanol injection prior to transurethral resection of the prostate (TURP) was studied in patients with benign prostatic hypertrophy (BPH). Perioperative blood loss was compared with patients who had undergone TURP with intraprostatic saline injection, with respect to the requiring time and irrigation volume, red blood cell count, hemoglobin, and hematocrit. To avert perioperative blood loss, intracapsular ethanol injection was attempted immediately before TURP for it is a definite thrombotherapeutic modality in management of esophageal varix. 1-3 The open study has been carried out investigating the use of ethanol to reduce a blood loss during TURE The preliminary results suggest that it may be an advantage for this treatment and a doubleblind study is being carried out. Katsushi Mori, M.D. Shigehiro Okamoto, M.D. Masao Akimoto, M.D. Nippon Medical School Hospital, Tokyo, Japan St. Luke's Hospital, Osaka, Japan,
REFERENCES 1. Terblanche J, Yakoob HI, Bornman PC, Stiegmann GV, Bane R, Jonker M, Wright J, and Kirsch R: Acute bleeding varices: a five year prospective evaluation of tamponade and sclerotherapy. Ann Surg 194: 521-530, 1981. 2. Yune HY, Klatte EC, Richmond BD, and Rabe FE: Absolute ethanol in thrombotherapy of bleeding esophageal varices. AJR Am J Roentgenol 138: 1137-1141, 1982. 3. Burgener FA, and Steinmetz SD: Treatment of experimental adenocarcinomas by percutaneous intratumoral injection of absolute ethanol. Invest Radiol 22: 472-478, 1987.
Urethral Warmer Survey TO THE EDITOR:
An issue currently before the FDA is the safety and efficacy of the urethral warmer from CMS (Cryomedical Sciences) used during transperineal cryoablation for the treatment of prostate cancer. On April 20, I sent a survey letter to 54 cryoablation sites in the United States. As of June 6, I had r e -
UROLOGY®/JANUARY1995 / VOLUME45, NUMBER1
ceived data from 46 sites for a response rate of 85%. These 46 sites performed a total of 2356 cases. A total of 19 complications were reported for a complication rate of 0.008. The complications noted were: Sloughed urethral tissue 6 Catheter frozen in place 5 Postop urinary retention 2 Leaking of urethral warmer 3 Incontinence 1 Meatal stenosis 1 Failure to flow 1 It should be appreciated that the urethral warmer was tested by numerous users in a variety of circumstances on a broad spectrum of patients. This suggests that the data affirm the safety and efficacy of the urethral warmer. However, it should be noted this information is preliminary and that additional data will be available in the near future. A multicenter study, enrolling 50 patients, is currently underway at five sites in the United States: Columbia University, New York City (Dr. Kaplan); Pennsylvania Hospital, Philadelphia (Dr. Malloy); U.C.S.D., San Diego (Dr. Schmidt); New England Medical Center, Boston (Dr. Long); and the University of Maryland, Baltimore (Dr. Jacobs and Dr. Naslund). Richard Milsten, M.D. Underwood Memorial Hospital Woodbury, New Jersey 08096
The Multicystic Dysplastic Kidney TO THE EDITOR:
I enjoyed reading the article by Drs. Emmert and King (The risk of hypertension is underestimated in the multicystic dysplastic kidney: a personal perspective. Urology44: 404-405, 1994). It just happens that I recently removed another multicystic kidney from a hypertensive baby and this is the third case of hypertension secondary to multicystic kidney in my practice. I also have two children who had infections develop in these dysplastic kidneys. I wholeheartedly agree with the authors' recommendation. Some years ago, I bought the trend of watching these kidneys but have come to realize that this is not the best approach for these children. Moneer K. Hanna,- M.D. 1010 Northern Blvd, Suite 126 Great Neck, New York 11021
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Intraprostatic Ethanol Injection Prior to Transurethral Resection of the Prostate for Prevention of Perioperative Blood Loss TO THE EDITOR:
The effectiveness of intracapsular ethanol injection prior to transurethral resection of the prostate (TURP) was studied in patients with benign prostatic hypertrophy (BPH). Perioperative blood loss was compared with patients who had undergone TURP with intraprostatic saline injection, with respect to the requiring time and irrigation volume, red blood cell count, hemoglobin, and hematocrit. To avert perioperative blood loss, intracapsular ethanol injection was attempted immediately before TURP for it is a definite thrombotherapeutic modality in management of esophageal varix. 1-3 The open study has been carried out investigating the use of ethanol to reduce a blood loss during TURE The preliminary results suggest that it may be an advantage for this treatment and a doubleblind study is being carried out. Katsushi Mori, M.D. Shigehiro Okamoto, M.D. Masao Akimoto, M.D. Nippon Medical School Hospital, Tokyo, Japan St. Luke's Hospital, Osaka, Japan,
REFERENCES 1. Terblanche J, Yakoob HI, Bornman PC, Stiegmann GV, Bane R, Jonker M, Wright J, and Kirsch R: Acute bleeding varices: a five year prospective evaluation of tamponade and sclerotherapy. Ann Surg 194: 521-530, 1981. 2. Yune HY, Klatte EC, Richmond BD, and Rabe FE: Absolute ethanol in thrombotherapy of bleeding esophageal varices. AJR Am J Roentgenol 138: 1137-1141, 1982. 3. Burgener FA, and Steinmetz SD: Treatment of experimental adenocarcinomas by percutaneous intratumoral injection of absolute ethanol. Invest Radiol 22: 472-478, 1987.
Urethral Warmer Survey TO THE EDITOR:
An issue currently before the FDA is the safety and efficacy of the urethral warmer from CMS (Cryomedical Sciences) used during transperineal cryoablation for the treatment of prostate cancer. On April 20, I sent a survey letter to 54 cryoablation sites in the United States. As of June 6, I had r e -
UROLOGY®/JANUARY1995 / VOLUME45, NUMBER1
ceived data from 46 sites for a response rate of 85%. These 46 sites performed a total of 2356 cases. A total of 19 complications were reported for a complication rate of 0.008. The complications noted were: Sloughed urethral tissue 6 Catheter frozen in place 5 Postop urinary retention 2 Leaking of urethral warmer 3 Incontinence 1 Meatal stenosis 1 Failure to flow 1 It should be appreciated that the urethral warmer was tested by numerous users in a variety of circumstances on a broad spectrum of patients. This suggests that the data affirm the safety and efficacy of the urethral warmer. However, it should be noted this information is preliminary and that additional data will be available in the near future. A multicenter study, enrolling 50 patients, is currently underway at five sites in the United States: Columbia University, New York City (Dr. Kaplan); Pennsylvania Hospital, Philadelphia (Dr. Malloy); U.C.S.D., San Diego (Dr. Schmidt); New England Medical Center, Boston (Dr. Long); and the University of Maryland, Baltimore (Dr. Jacobs and Dr. Naslund). Richard Milsten, M.D. Underwood Memorial Hospital Woodbury, New Jersey 08096
The Multicystic Dysplastic Kidney TO THE EDITOR:
I enjoyed reading the article by Drs. Emmert and King (The risk of hypertension is underestimated in the multicystic dysplastic kidney: a personal perspective. Urology44: 404-405, 1994). It just happens that I recently removed another multicystic kidney from a hypertensive baby and this is the third case of hypertension secondary to multicystic kidney in my practice. I also have two children who had infections develop in these dysplastic kidneys. I wholeheartedly agree with the authors' recommendation. Some years ago, I bought the trend of watching these kidneys but have come to realize that this is not the best approach for these children. Moneer K. Hanna,- M.D. 1010 Northern Blvd, Suite 126 Great Neck, New York 11021
1 -11