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Air and carbon dioxide cystometry
LETTERS TO THE EDITOR
AIR AND CARBON DIOXIDE CYSTOMETRY
I would highly endorse the modified procedure by either technique.
To the Editor: We share Dr. Merrill’s sentiments (Letter to the Editor, UROLOGY, vol. 4, page 495) in recommending that air cystometry be discontinued in favor of carbon dioxide (C02) cystometry. We have manufactured and marketed a compact, inexpensive CO2 adaptor for use with our air cystometer since November, 1973 - well before any report of air embolism. When Dr. Keitzer * notified us of the fatality, we informed our customers by letter of this incident and have subsequently sent them a second letter. We have discontinued manufacturing the Mode1 I500 Air Cystometer and have replaced it with the Mode1 1550 CO2 Cystometer. G. R. Atwood, President LT Instruments, Inc. Houston, Texas 77036 *Keitzer, W. A.: Personal communication,
April 3, 1974.
A MODIFICATION OF HRYNTSHAK TECHNIQUE To the Editor: I was very interested in the article, “Suprapubic Prostatectomy: Modified Hryntshak Technique,” by Roy Witherington, M.D., and W. C. Shelor, Jr., M.D., in the November issue (vol. 4, page 550) of UROLOGY. This was the same method successfully employed by Dr. C. D. Creevy in 1959, during my residency at the University of Minnesota Hospitals. However, in 1961, while I was an instructor at Downstate Medical Center, in Brooklyn, New York, Dr. Andrew McGowan and Dr. Frank Hamm developed another simplification of the Hryntshak technique which was reported at the New York Section, AUA, Essay Contest in 1962. Since then I have used this method with great success and satisfaction. In this modification, the plain sutures are placed longitudinally from posterior to anterior vesical neck, closing the neck transversely. The sutures can be placed much more rapidly and with greater ease; there is less tension so that 3-O plain catgut can be used. It is not necessary to tie the sutures around the catheter making the ties easier. The bladder is still closed primarily.
288
Hryntshak
Gerald Litzky, M.D. 191 Engle Street Englewood, New Jersey 07631
GRADING SYSTEM URETERALREFLUX
FOR
To the Editor: The editorial on “A Plea for Grading Vesicoureteric Reflux” by Arnold H. Colodny, M.D., and Robert L. Lebowitz, M.D., in the September issue (vol. 4, page 357) of UROLOGY was very timely. However, it should be pointed out that a system for grading vesicoureteric reflux associated with a longterm prognostic’ evaluation was first published by a group from Christchurch, New Zealand, in 1970.’ They treated a large group of infants with documented ureteral reflux for many years with only conservative, nonsurgical therapy. All these children were evaluated with intravenous pyelograms and voiding cystourethrograms. Reflux in all cystograms was graded into three categories: slight reflux being equivalent to grade 1 mentioned by Colodny and Lebowitz; moderate reflux equivalent to grades 2A and 2B; and gross reflux equivalent to grades 3 and 4. They noted that grade 3 or gross reflux was associated with a high incidence of initial renal damage. They also found that those patients with grades 3 and 4 reflux had a high incidence of progressive renal scarring. Furthermore, in a two-to-nine-year follow-up of 58 children with moderate reflux (grades 2A and 2B) treated without surgical intervention, scarring of the renal parenchyma developed in only 1 chi1d.2 These data strongly suggest that patients with less than gross reflux are at little risk in terms of further renal scarring developing. Considering this fact, I think it would behoove many urologists, as Dr. Colodny and Dr. Lebowitz suggested, to document the degree of reflux that they are correcting or treating. Certainly, the group from Christchurch would make it appear that many patients with reflux in the United States are being treated surgically when the degree of reflux would probably cease spontaneously or would cause no significant progressive renal damage. To inflict any significant complications by a surgical procedure in this group
UROLOGY I FEBRUARY 1975 i VOLUME V, NUMBER 2
AIR AND CARBON DIOXIDE CYSTOMETRY
I would highly endorse the modified procedure by either technique.
To the Editor: We share Dr. Merrill’s sentiments (Letter to the Editor, UROLOGY, vol. 4, page 495) in recommending that air cystometry be discontinued in favor of carbon dioxide (C02) cystometry. We have manufactured and marketed a compact, inexpensive CO2 adaptor for use with our air cystometer since November, 1973 - well before any report of air embolism. When Dr. Keitzer * notified us of the fatality, we informed our customers by letter of this incident and have subsequently sent them a second letter. We have discontinued manufacturing the Mode1 I500 Air Cystometer and have replaced it with the Mode1 1550 CO2 Cystometer. G. R. Atwood, President LT Instruments, Inc. Houston, Texas 77036 *Keitzer, W. A.: Personal communication,
April 3, 1974.
A MODIFICATION OF HRYNTSHAK TECHNIQUE To the Editor: I was very interested in the article, “Suprapubic Prostatectomy: Modified Hryntshak Technique,” by Roy Witherington, M.D., and W. C. Shelor, Jr., M.D., in the November issue (vol. 4, page 550) of UROLOGY. This was the same method successfully employed by Dr. C. D. Creevy in 1959, during my residency at the University of Minnesota Hospitals. However, in 1961, while I was an instructor at Downstate Medical Center, in Brooklyn, New York, Dr. Andrew McGowan and Dr. Frank Hamm developed another simplification of the Hryntshak technique which was reported at the New York Section, AUA, Essay Contest in 1962. Since then I have used this method with great success and satisfaction. In this modification, the plain sutures are placed longitudinally from posterior to anterior vesical neck, closing the neck transversely. The sutures can be placed much more rapidly and with greater ease; there is less tension so that 3-O plain catgut can be used. It is not necessary to tie the sutures around the catheter making the ties easier. The bladder is still closed primarily.
288
Hryntshak
Gerald Litzky, M.D. 191 Engle Street Englewood, New Jersey 07631
GRADING SYSTEM URETERALREFLUX
FOR
To the Editor: The editorial on “A Plea for Grading Vesicoureteric Reflux” by Arnold H. Colodny, M.D., and Robert L. Lebowitz, M.D., in the September issue (vol. 4, page 357) of UROLOGY was very timely. However, it should be pointed out that a system for grading vesicoureteric reflux associated with a longterm prognostic’ evaluation was first published by a group from Christchurch, New Zealand, in 1970.’ They treated a large group of infants with documented ureteral reflux for many years with only conservative, nonsurgical therapy. All these children were evaluated with intravenous pyelograms and voiding cystourethrograms. Reflux in all cystograms was graded into three categories: slight reflux being equivalent to grade 1 mentioned by Colodny and Lebowitz; moderate reflux equivalent to grades 2A and 2B; and gross reflux equivalent to grades 3 and 4. They noted that grade 3 or gross reflux was associated with a high incidence of initial renal damage. They also found that those patients with grades 3 and 4 reflux had a high incidence of progressive renal scarring. Furthermore, in a two-to-nine-year follow-up of 58 children with moderate reflux (grades 2A and 2B) treated without surgical intervention, scarring of the renal parenchyma developed in only 1 chi1d.2 These data strongly suggest that patients with less than gross reflux are at little risk in terms of further renal scarring developing. Considering this fact, I think it would behoove many urologists, as Dr. Colodny and Dr. Lebowitz suggested, to document the degree of reflux that they are correcting or treating. Certainly, the group from Christchurch would make it appear that many patients with reflux in the United States are being treated surgically when the degree of reflux would probably cease spontaneously or would cause no significant progressive renal damage. To inflict any significant complications by a surgical procedure in this group
UROLOGY I FEBRUARY 1975 i VOLUME V, NUMBER 2