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A Convertible Nontraumatic Cystourethroscope
A CONVERTIBLE NONTRAUMATIC CYSTOURETHROSCOPE PETER J. RIABOFF
This cystourethroscope was devised (1), to combine the features of a cystoscope and urethroscope, (2) to produce less trauma during manipulation in the urethra, and (3) to simplify work on the ureters by increasing the capacity for accommodation of the ureteral catheters and bougies. The sheath of the instrument is straight and 24 F. calibre, oval shape in cross section, with 6½ inches working length. This instrument could be made in 26 F. and 28 F. calibre, and also in lengths of 8 inches for the male and 4 inches for the female. The fenestra of the sheath is obliquely formed with the edges well thickened and rounded to prevent trauma in introduction and during manipulation in the urethra. The stopcocks are a new design and conventionally mounted on the proximal end adjacent to the lock. The telescope follows the design of the McCarthy foroblique system and provides accurate forward vision combined with a deflection of 25°. The lamp is mounted on a separate wire light carrier attached to the telescope, and is located beside the objective lens to give better illumination of inspecting areas. The design of the two outside, or catherizing guides, is unique, in that they are longer and larger than usual and curved outward to carry the catheters away from the face of the operator. A removable fin is clipped to the telescope to provide the convertible feature, or enable the instrument to fulfill the dual function of double catheterizing and operating. With the fins in place, the instrument readily accomodates two No. 7 F. catheters or bougies. When the fin is removed a No. 11 catheter or bougie may be passed through the middle operating guide with two No. 5 F. catheters through the outside catheterizing guides. The following combinations may be passed through the middle and outside guides-(6.8.7.), (6.9.6.), and (6.10.5.) or in summary equal to 21 F. This unusual capacity for the accommodation of the catheters and bougies, which no other instrument possesses, simplifies manipulation of the ureters. Once the instrument is introduced, it may be moved from the posterior 356
CONVERTIBLE NONTRAUMATIC CYSTOURETHROSCOPE
3S7
urethra into the bladder, then back and forth with the greatest ease and no discomfort to the patient. When the instrument is in the urethra, it requires no constant running water. Observation of all the details in the urethra and manipulation in it could be accomplished with water left in the sheath after turning off the stopcock. remarkable clearness the entire urethra presents itself in the visual field without rotating the instrument. Vesical neck, prostatic sinuses and verumontanum could be studied at close range. Ejaculatory ducts are easily identified.
The anterior urethra could be examined under air distention. This method is particularly helpful in searching for the opening of Cowper's glands and pathological changes in the bulbous part of the urethra. In the female urethra, this instrument gives great satisfaction because there is no need for constant running water. The cystourethroscope could be slowly moved in and out of the bladder, and the urethra carefully studied without fear of the instrument being expelled by an overdistended bladder. I am grateful to Mr. Frederick C. Wappler, President of the American Cystoscope Makers, Inc., for the splendid execution of this instrument from my drawings.
1146 Park
1_Vcw Yorl;,, City
This cystourethroscope was devised (1), to combine the features of a cystoscope and urethroscope, (2) to produce less trauma during manipulation in the urethra, and (3) to simplify work on the ureters by increasing the capacity for accommodation of the ureteral catheters and bougies. The sheath of the instrument is straight and 24 F. calibre, oval shape in cross section, with 6½ inches working length. This instrument could be made in 26 F. and 28 F. calibre, and also in lengths of 8 inches for the male and 4 inches for the female. The fenestra of the sheath is obliquely formed with the edges well thickened and rounded to prevent trauma in introduction and during manipulation in the urethra. The stopcocks are a new design and conventionally mounted on the proximal end adjacent to the lock. The telescope follows the design of the McCarthy foroblique system and provides accurate forward vision combined with a deflection of 25°. The lamp is mounted on a separate wire light carrier attached to the telescope, and is located beside the objective lens to give better illumination of inspecting areas. The design of the two outside, or catherizing guides, is unique, in that they are longer and larger than usual and curved outward to carry the catheters away from the face of the operator. A removable fin is clipped to the telescope to provide the convertible feature, or enable the instrument to fulfill the dual function of double catheterizing and operating. With the fins in place, the instrument readily accomodates two No. 7 F. catheters or bougies. When the fin is removed a No. 11 catheter or bougie may be passed through the middle operating guide with two No. 5 F. catheters through the outside catheterizing guides. The following combinations may be passed through the middle and outside guides-(6.8.7.), (6.9.6.), and (6.10.5.) or in summary equal to 21 F. This unusual capacity for the accommodation of the catheters and bougies, which no other instrument possesses, simplifies manipulation of the ureters. Once the instrument is introduced, it may be moved from the posterior 356
CONVERTIBLE NONTRAUMATIC CYSTOURETHROSCOPE
3S7
urethra into the bladder, then back and forth with the greatest ease and no discomfort to the patient. When the instrument is in the urethra, it requires no constant running water. Observation of all the details in the urethra and manipulation in it could be accomplished with water left in the sheath after turning off the stopcock. remarkable clearness the entire urethra presents itself in the visual field without rotating the instrument. Vesical neck, prostatic sinuses and verumontanum could be studied at close range. Ejaculatory ducts are easily identified.
The anterior urethra could be examined under air distention. This method is particularly helpful in searching for the opening of Cowper's glands and pathological changes in the bulbous part of the urethra. In the female urethra, this instrument gives great satisfaction because there is no need for constant running water. The cystourethroscope could be slowly moved in and out of the bladder, and the urethra carefully studied without fear of the instrument being expelled by an overdistended bladder. I am grateful to Mr. Frederick C. Wappler, President of the American Cystoscope Makers, Inc., for the splendid execution of this instrument from my drawings.
1146 Park
1_Vcw Yorl;,, City