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Transurethral urethrotomy under vision for urethral strictures and vesical neck contractures
BOOK AND FILM REVIEWS
BOOK REVIEW By G. Gallo, M.D. Renal Pathology in Biopsy by H. U. Zollinger and MM.J. Mihatsh New York, Springer-Verlag, 1978, $85. The widespread use of the renal biopsy examined with more sophisticated tools to define structural abnormalities in renal disease, and the correlation of structural and clinical abnormalities have provided many new observations and a proliferation of publications relevant to renal disease. This has resulted in the need for a textbook of renal pathology that consolidates, synthesizes, and successfully updates accumulated data from the past twenty-five years. Renal Pathology in Biopsy is one of the best attempts to date to bring it all together in a useful way. The authors have produced an exhaustive work based on their own twenty years of experience and have related their observations to those in the literature. They have avoided the anecdotal kind of coverage and have instead presented well-discussed topics with extensive bibliography that serves as an excellent source of reference for the serious student of renal pathology. The format they have chosen for presentation is effective. The early chapters deal with general topics of techniques and procedures, normal renal structure, and general overview of morphologic alterations occurring in specific structures of the kidney. The later chapters of the book .deal with specific disease entities. The text is richly illustrated with technically superb and well-chosen micrographs. This text, in summary, treats the whole subject of renal pathology with the possible exception of experimental nephritis. ‘It is thus much broader in scope than the title would indicate, but it is geared to the practical aspects of renal pathology. This book has a lot of information, and facts are carefully documented with appropriate references. Thus, it is not an easy book to read in a leisurely way by the general reader. But it is a pleasure for those serious students of the kidney, both nephrologists and pathologists, who are looking for factual information. This is a worthy addition to the reference shelf and is highly recommended as an encyclopedic textbook of renal pathology.
FILM REVIEWS By Lawrence Fish,
M.D.
Surgery of Duplex Kidney: Segmental Nephrectomy Arjan D. Amar The approach to diagnosis and surgical treatment of the kidney with the duplicated collecting system
was discussed. The surgical anatomy and blood supply were shown, and indications for segmental IFphrectomy were presented. Dr. Amar emphasized the use of ureteral catheters prior to surgery to aid in quickly identifying the duplicated ureters. Surgical excision of an upper renal segment and its ureter was demonstrated followed by a second caSe where a lower renal segment was excised. In both cases, residual renal capsule was saved and used to cover the amputated end. The film has good animation and photography and is a nice addition to a teaching library on surgical technique. Transpubic Suspension of the Bladder Neck Reginald Hancock This film demonstrates another of the many variations of the Marshall-Marchetti-Krantz procedure for urinary incontinence. However, instead of suspending the bladder neck and urethra to the pubis by a suture through the pubic periosteum four holes are drilled into the pubic symphysis and the sutures brought through and tied above the pubis parallel to the line of the urethra. He uses non-absorbable Prolene. To pass the suture through the drilled hole, the surgeon takes a Keith needle and passes it through the hole backwards and then threads the needle with the suture and pulls the needle back through the hole with the attached suture. The film demonstrated this technique adequately. The only comments were the paucity of sutures used in the suspension and the fear of osteitis pubis from the drilling. Anterior Transposition of Urethra Chester C. Winter This film presented a technique for correction of urinary incontinence in females with neurogenic bladder, patulous urethra, and persistant loss of urine despite the use of a Foley catheter. With the patient in the prone position, the urethra and its attached anterior vaginal vault and mucosa is mobilized from the surrounding perineal tissue. The vaginal mucosa is then fashioned into a tube and used to increase urethral length. The extended urethra is then transposed to the suprapubic area. The film was succinct, well edited, and audiovisual presentation of good quality. The procedure would appear to be one of very limited use. Transurethral Urethrotomy Under Vision for Urethral Strictures and Vesical Neck Contractures James A. Tremann This film utilized a new instrument developed the Karl Storz Endoscopy Corp. The instrument
by is
an optical urethrotome using a precision cold knife, a 0” telescope lens which attaches to an Iglesias resectoscope element and fits into a 20 F sheath. There is also a channel to pass a filiform which is of use in determining a false passage from the true stricture. The stricture is cut at the 12 o’clock position under direct vision and from the distal to the proximal portion of the stricture. Postoperatively a Foley catheter is left indwelling for twenty-four to forty-eight hours. The patient is also instructed in hydraulic distention of the urethra by squeezing the urethral meatus shut manually during voiding. One of the criticisms put forth in the discussion after the film was that follow-up had only been for sixteen months. Technically the film was excellent, with some of the best endoscopic photography.
Implantation of an Artificial Sphinter in a Pediatric Patient F. Brantley Scott This film demonstrates a new approach to the pediatric patient with neurogenic bladder and secondary to neurologic dissphincter dysfunction, ease. Dr. Scott performs an external urethrotomy, urodynamic evaluation, and implantation of an artificial inflatable sphincter prosthesis during one anesthesia period. The prosthesis is discussed in detail, with its reservoir. sphincter, inflation and deflation pumps, and tubing. The surgeon emphasizes that this type of surgery should not be performed by urologists who are not well versed in urodynamics. The procedure has been performed on 50 children with 80-85 per cent success. The failures have been due to mechanical failure and infection. The only potential problem in performing this procedure on children is the possibility of upward migration of the pumps during growth. Technically the film was excellent. with good editing, photography. and narration.
Visits in Urology: The Prostate Gland Eaton Laboratories This is another in a series of “visits.” Dr. John T. Grayhack, chairman, Department of Urology, Northwestern University, meets with Dr. \V. W. Scott at the Johns Hopkins Hospital to discuss current treatment of benign and malignant prostatic disease. They both agree that the indications for surgical treatment of BPH are not absolute. A perineal prostatectomy for benign disease is demonstrated. They then discuss the treatment of the various stages of carcinoma, and both believe that Stage A lesions should be observed. In Stage B lesions, Dr. Scott favors a radical prostatectomy but adds that the grade of differentiation is very important in determining prognosis. A visit to the Johns Hopkins research laboratory revealed that a prostatic tumor model in rats had been developed for the purpose of testing chemotherapeutic agents. Radical Perineal Prostatectomy 0. >I. Lilien In this film, Dr. Lilien specifically mentioned that he believes that radical perineal prostatectomy should only be performed for Stage B lesions and in patients who will have ten-year survival rate according to actuarial tables. The procedure as filmed shows only slight modifications of the original Young-Jewett procedure. He does not catheterize the ureters prior to resection of the prostate and brings out drains through a separate stab wound in the perineum. The Foley catheter is removed in ten days and the patient is immediately taught anal sphincter exercise for continence. In his hand he has 5-10 per cent incontinence. He mentioned that should laceration of the rectum occur early in the procedure, it is carefillly repaired and the procedure abandoned. Technically the film was good, despite the fact that it is hard to visualize the perineum well. There was also a good anatomic discussion of the perinemn.
BOOK REVIEW By G. Gallo, M.D. Renal Pathology in Biopsy by H. U. Zollinger and MM.J. Mihatsh New York, Springer-Verlag, 1978, $85. The widespread use of the renal biopsy examined with more sophisticated tools to define structural abnormalities in renal disease, and the correlation of structural and clinical abnormalities have provided many new observations and a proliferation of publications relevant to renal disease. This has resulted in the need for a textbook of renal pathology that consolidates, synthesizes, and successfully updates accumulated data from the past twenty-five years. Renal Pathology in Biopsy is one of the best attempts to date to bring it all together in a useful way. The authors have produced an exhaustive work based on their own twenty years of experience and have related their observations to those in the literature. They have avoided the anecdotal kind of coverage and have instead presented well-discussed topics with extensive bibliography that serves as an excellent source of reference for the serious student of renal pathology. The format they have chosen for presentation is effective. The early chapters deal with general topics of techniques and procedures, normal renal structure, and general overview of morphologic alterations occurring in specific structures of the kidney. The later chapters of the book .deal with specific disease entities. The text is richly illustrated with technically superb and well-chosen micrographs. This text, in summary, treats the whole subject of renal pathology with the possible exception of experimental nephritis. ‘It is thus much broader in scope than the title would indicate, but it is geared to the practical aspects of renal pathology. This book has a lot of information, and facts are carefully documented with appropriate references. Thus, it is not an easy book to read in a leisurely way by the general reader. But it is a pleasure for those serious students of the kidney, both nephrologists and pathologists, who are looking for factual information. This is a worthy addition to the reference shelf and is highly recommended as an encyclopedic textbook of renal pathology.
FILM REVIEWS By Lawrence Fish,
M.D.
Surgery of Duplex Kidney: Segmental Nephrectomy Arjan D. Amar The approach to diagnosis and surgical treatment of the kidney with the duplicated collecting system
was discussed. The surgical anatomy and blood supply were shown, and indications for segmental IFphrectomy were presented. Dr. Amar emphasized the use of ureteral catheters prior to surgery to aid in quickly identifying the duplicated ureters. Surgical excision of an upper renal segment and its ureter was demonstrated followed by a second caSe where a lower renal segment was excised. In both cases, residual renal capsule was saved and used to cover the amputated end. The film has good animation and photography and is a nice addition to a teaching library on surgical technique. Transpubic Suspension of the Bladder Neck Reginald Hancock This film demonstrates another of the many variations of the Marshall-Marchetti-Krantz procedure for urinary incontinence. However, instead of suspending the bladder neck and urethra to the pubis by a suture through the pubic periosteum four holes are drilled into the pubic symphysis and the sutures brought through and tied above the pubis parallel to the line of the urethra. He uses non-absorbable Prolene. To pass the suture through the drilled hole, the surgeon takes a Keith needle and passes it through the hole backwards and then threads the needle with the suture and pulls the needle back through the hole with the attached suture. The film demonstrated this technique adequately. The only comments were the paucity of sutures used in the suspension and the fear of osteitis pubis from the drilling. Anterior Transposition of Urethra Chester C. Winter This film presented a technique for correction of urinary incontinence in females with neurogenic bladder, patulous urethra, and persistant loss of urine despite the use of a Foley catheter. With the patient in the prone position, the urethra and its attached anterior vaginal vault and mucosa is mobilized from the surrounding perineal tissue. The vaginal mucosa is then fashioned into a tube and used to increase urethral length. The extended urethra is then transposed to the suprapubic area. The film was succinct, well edited, and audiovisual presentation of good quality. The procedure would appear to be one of very limited use. Transurethral Urethrotomy Under Vision for Urethral Strictures and Vesical Neck Contractures James A. Tremann This film utilized a new instrument developed the Karl Storz Endoscopy Corp. The instrument
by is
an optical urethrotome using a precision cold knife, a 0” telescope lens which attaches to an Iglesias resectoscope element and fits into a 20 F sheath. There is also a channel to pass a filiform which is of use in determining a false passage from the true stricture. The stricture is cut at the 12 o’clock position under direct vision and from the distal to the proximal portion of the stricture. Postoperatively a Foley catheter is left indwelling for twenty-four to forty-eight hours. The patient is also instructed in hydraulic distention of the urethra by squeezing the urethral meatus shut manually during voiding. One of the criticisms put forth in the discussion after the film was that follow-up had only been for sixteen months. Technically the film was excellent, with some of the best endoscopic photography.
Implantation of an Artificial Sphinter in a Pediatric Patient F. Brantley Scott This film demonstrates a new approach to the pediatric patient with neurogenic bladder and secondary to neurologic dissphincter dysfunction, ease. Dr. Scott performs an external urethrotomy, urodynamic evaluation, and implantation of an artificial inflatable sphincter prosthesis during one anesthesia period. The prosthesis is discussed in detail, with its reservoir. sphincter, inflation and deflation pumps, and tubing. The surgeon emphasizes that this type of surgery should not be performed by urologists who are not well versed in urodynamics. The procedure has been performed on 50 children with 80-85 per cent success. The failures have been due to mechanical failure and infection. The only potential problem in performing this procedure on children is the possibility of upward migration of the pumps during growth. Technically the film was excellent. with good editing, photography. and narration.
Visits in Urology: The Prostate Gland Eaton Laboratories This is another in a series of “visits.” Dr. John T. Grayhack, chairman, Department of Urology, Northwestern University, meets with Dr. \V. W. Scott at the Johns Hopkins Hospital to discuss current treatment of benign and malignant prostatic disease. They both agree that the indications for surgical treatment of BPH are not absolute. A perineal prostatectomy for benign disease is demonstrated. They then discuss the treatment of the various stages of carcinoma, and both believe that Stage A lesions should be observed. In Stage B lesions, Dr. Scott favors a radical prostatectomy but adds that the grade of differentiation is very important in determining prognosis. A visit to the Johns Hopkins research laboratory revealed that a prostatic tumor model in rats had been developed for the purpose of testing chemotherapeutic agents. Radical Perineal Prostatectomy 0. >I. Lilien In this film, Dr. Lilien specifically mentioned that he believes that radical perineal prostatectomy should only be performed for Stage B lesions and in patients who will have ten-year survival rate according to actuarial tables. The procedure as filmed shows only slight modifications of the original Young-Jewett procedure. He does not catheterize the ureters prior to resection of the prostate and brings out drains through a separate stab wound in the perineum. The Foley catheter is removed in ten days and the patient is immediately taught anal sphincter exercise for continence. In his hand he has 5-10 per cent incontinence. He mentioned that should laceration of the rectum occur early in the procedure, it is carefillly repaired and the procedure abandoned. Technically the film was good, despite the fact that it is hard to visualize the perineum well. There was also a good anatomic discussion of the perinemn.