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A cystoscope for fulguration of bladder tumors
390
AmericanJournalof Surgery
Section of Genito-Urinary
This meta1 tube has numerous perforations pIaced in a spira1 manner so that shouId one become plugged the Iower ones wouId continue to function. This Iong tube is passed through a meta button with a centra1 perforation suppIied with a rubber bushing, so that the suction tube may act as a pIunger using the button as a fuIcrum. This button has a second channe1 that opens on the side. This is the inIet channe1, aIIowing the air to enter so as to avoid the production of a vacuum within the bIadder; thus avoiding traumatizing the surrounding tissues. Due to the fact that the mushroom of the Pezzer catheter is diffrcuIt to introduce unIess pIaced on the stretch, the suction tube can be pressed down, using the IateraI arms of the button for the counterpressure, placing the mushroom on the stretch and making it easy of introduction and remova1. The meta inner tube avoids the possibiIity of coIIapse which occurs when soft rubber tubes are used. By means of the inIet Iocated on the button of the inner tube, we are doubIy protected, in that shouId the suction stop for some unknown reason this inIet serves as an outflow for the urine. The tube may be inserted on the operating tabIe. After six to ten days, when a definite suprapubic IistuIa has been estabIished, this tube is of no vaIue, for it prevents cIosure of the bIadder. We then use the GiIe tube, which is composed of smaI1 inner and outer perforated meta tubes suspended from a circuIar pIate. This tube is 1.3 inches Iong and does not extend into the bIadder, thus aIIowingvthe Iatter to cIose. A CYSTOSCOPE FOR FULGURATION BLADDER TUMORS OSWALD
S. LOWSLEY,
OF
M.D.
(Author’s abstract)
In this recentIy devised instrument, the teIescope is based upon the McCarthy Iens system, the resuIt being that it deflects the angIe of the optica axis 25O instead of the customary right angIe. The advantages cIaimed for the instrument are: I. It is smaI1 and easiIy passed into the bIadder. 2. The teIescope and Iight are contained entireIy within the shaft of the instrument, thus aIIowing the greatest possibIe motiIity in the conduct of intravesica1 fuIguration. 3. It has a Iarge meta eIectrode at the end
Surgery
APRIL,,927
of the curved portion, size 22 F, which causes extensive disintegration of a tumor mass under vision. This eIectrode is thoroughIy insuIated. 4. Continuous irrigation through the fenestra is possibIe, which insures a cIear heId at the point of appIication of the spark, even in the presence of considerabIe hemorrhage. 3. The forward or obIique-Iooking Iens system of McCarthy makes it possibIe to keep the eIectrode in the heId of vision at a11 times. 6. The expense of the instrument is greatIy reduced by the fact that any McCarthy teIescope can be used in it. AN IRRIGATING CYSTO-URETHROSCOPE FOR APPLYING HEAT TO THE PROSTATE AND VESICAL ORIFICE UNDER VISION OSWALD
S.
(Author’s
LOWSLEY
abstract)
The object of this instrument is to appIy heat under vision to the prostate and vesica1 orifice in an attempt to ameliorate not 0nIy ordinary chronic inflammatory Iesions of these structures but a11 diseases of the prostate and posterior urethra. By it heat is intended to be appIied under vision to such a degree that a draining of the tissues wiI1 resuIt, thereby insuring permanent as we11 as temporary reIief of symptoms. The advantages cIaimed are: I. The instrument has a Iarge eIectrode for the purpose of appIying heat in such quantities that a vigorous. drainage of the prostate and vesica1 orifice resuhs. 2. Its action is observabIe during the heating process. 3. Provision is made for constant irrigation, 4. Any McCarthy obIique vision teIescope may be utiIized in this instrument. Discussion DR. LEO MICHEL: Dr. LowsIey is, as usua1,
very ingenious. The fuIgurating apparatus seems to me to be a spIendid instrument where one wants to apply a Iarge surface and can reach a point for fuIguration. Often in bIadder work I have tried to reach a spot that I couId not touch with the shaft of my instrument or the end of the instrument; I couId not reach it with either the Bugbee or the McCarthy eIectrode. I have never used this instrument, but say this because of my experience with other instruments.
AmericanJournalof Surgery
Section of Genito-Urinary
This meta1 tube has numerous perforations pIaced in a spira1 manner so that shouId one become plugged the Iower ones wouId continue to function. This Iong tube is passed through a meta button with a centra1 perforation suppIied with a rubber bushing, so that the suction tube may act as a pIunger using the button as a fuIcrum. This button has a second channe1 that opens on the side. This is the inIet channe1, aIIowing the air to enter so as to avoid the production of a vacuum within the bIadder; thus avoiding traumatizing the surrounding tissues. Due to the fact that the mushroom of the Pezzer catheter is diffrcuIt to introduce unIess pIaced on the stretch, the suction tube can be pressed down, using the IateraI arms of the button for the counterpressure, placing the mushroom on the stretch and making it easy of introduction and remova1. The meta inner tube avoids the possibiIity of coIIapse which occurs when soft rubber tubes are used. By means of the inIet Iocated on the button of the inner tube, we are doubIy protected, in that shouId the suction stop for some unknown reason this inIet serves as an outflow for the urine. The tube may be inserted on the operating tabIe. After six to ten days, when a definite suprapubic IistuIa has been estabIished, this tube is of no vaIue, for it prevents cIosure of the bIadder. We then use the GiIe tube, which is composed of smaI1 inner and outer perforated meta tubes suspended from a circuIar pIate. This tube is 1.3 inches Iong and does not extend into the bIadder, thus aIIowingvthe Iatter to cIose. A CYSTOSCOPE FOR FULGURATION BLADDER TUMORS OSWALD
S. LOWSLEY,
OF
M.D.
(Author’s abstract)
In this recentIy devised instrument, the teIescope is based upon the McCarthy Iens system, the resuIt being that it deflects the angIe of the optica axis 25O instead of the customary right angIe. The advantages cIaimed for the instrument are: I. It is smaI1 and easiIy passed into the bIadder. 2. The teIescope and Iight are contained entireIy within the shaft of the instrument, thus aIIowing the greatest possibIe motiIity in the conduct of intravesica1 fuIguration. 3. It has a Iarge meta eIectrode at the end
Surgery
APRIL,,927
of the curved portion, size 22 F, which causes extensive disintegration of a tumor mass under vision. This eIectrode is thoroughIy insuIated. 4. Continuous irrigation through the fenestra is possibIe, which insures a cIear heId at the point of appIication of the spark, even in the presence of considerabIe hemorrhage. 3. The forward or obIique-Iooking Iens system of McCarthy makes it possibIe to keep the eIectrode in the heId of vision at a11 times. 6. The expense of the instrument is greatIy reduced by the fact that any McCarthy teIescope can be used in it. AN IRRIGATING CYSTO-URETHROSCOPE FOR APPLYING HEAT TO THE PROSTATE AND VESICAL ORIFICE UNDER VISION OSWALD
S.
(Author’s
LOWSLEY
abstract)
The object of this instrument is to appIy heat under vision to the prostate and vesica1 orifice in an attempt to ameliorate not 0nIy ordinary chronic inflammatory Iesions of these structures but a11 diseases of the prostate and posterior urethra. By it heat is intended to be appIied under vision to such a degree that a draining of the tissues wiI1 resuIt, thereby insuring permanent as we11 as temporary reIief of symptoms. The advantages cIaimed are: I. The instrument has a Iarge eIectrode for the purpose of appIying heat in such quantities that a vigorous. drainage of the prostate and vesica1 orifice resuhs. 2. Its action is observabIe during the heating process. 3. Provision is made for constant irrigation, 4. Any McCarthy obIique vision teIescope may be utiIized in this instrument. Discussion DR. LEO MICHEL: Dr. LowsIey is, as usua1,
very ingenious. The fuIgurating apparatus seems to me to be a spIendid instrument where one wants to apply a Iarge surface and can reach a point for fuIguration. Often in bIadder work I have tried to reach a spot that I couId not touch with the shaft of my instrument or the end of the instrument; I couId not reach it with either the Bugbee or the McCarthy eIectrode. I have never used this instrument, but say this because of my experience with other instruments.