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Electrocautery circumcision
rami, anterior perineum, urogenital diaphragm, and genitalia en bloc with the pelvic organs and lymph nodes with diverting ileal conduit at Memorial Hospital. A report on that latter ex-perience is in preparation. Frederick A. Klein, M.D. Willet F. Whitmore, Jr., M.D. Memorial Sloan-Kettering Cancer Center New York, New York 10021 A SIMPLER METHOD BLADDER IRRIGATION
FOR CONTINUOUS
To the Editor: I read with much interest the article by P. M. Livne et al., “Simple Method of Continuous Bladder Irrigation for Prevention of Postprostatectomy Complications,” published in the March (vol. 19, pages 314-315, 1982) of UROLOGY. I endorse their use of a twocatheter system for bladder irrigation; I always have thought that the continuous irrigation catheters commercially available have the disadvantage of a decreased outflow lumen. However, I wish to propose an even simpler method which has had good success, and with widei application. Livne et al. advocate the use of a whistletip catheter. In insuring against postprostatectomy complications, I think it is imperative to use a catheter which can supply traction. Accordingly, I use a 24-F, 30-cc balloon Foley catheter. My inflow is provided through the peripheral central venous pressure (CVP) line supplied with a 14- or 16-gauge needle. The needle permits oblique insertion into the catheter lumen opposite the balloon inflow valve (Fig. 1). The CVP line is then passed so that it exits from the eye. The stylet is then removed. and the metal wire is severed from the plastic cap, The CVP line is then cut, leaving enough
FIGURE catheter through
110
1.
Needle of CVP obliquely stylet allows easy advancement catheter lumen.
inserted; of line
FIGURE 2. Complete continuous irrigation system, note amount of CVP line exiting .from catheter eyra. and plastic guard as good aid .for proper tethering to thigh.
through the eye so that it can be bent back to allow smooth passage into the bladder. The plastic cap is retained to use as a sterile barrier when the inflow line is not in use. Irrigation is supplied through a simple intravenous line. The plastic guard which is provided for the protection of the CVP line as it passes through the cutting end of the insertion needle allows for good tethering to the leg (Fig. 2). When no longer necessary, the CVP line can be withdrawn easily: from the catheter, the oblique angle of entry preventing any- leakage of fluid. This simple system can be used in any situation requiring continuous bladder irrigation, does not require side by side catheters. and does not need suture materials or tape on the catheter. David Jay Caro, M.D. 100 NE Randolph Peoria, Illinois 61604 ELECTROCAUTERY
CIRCUMCISION
To the Editor: I was dismayed to note A. Barry Belman’s article, “Electrocautery Circumcision,” published in the November issue (vol. 18, pages 506-507, 1981) of UROLOGY, and especially the absence of editorial caveat. I cannot give the citations, but I know that there has been at least one disastrous complication of circumcision by cautery, resulting in substantial penile loss for the patient, and monetary gain for his lawyer. As I recall, this also involved the use of a Gomco clamp, which is not part of Dr. Belman’s technique. The facility of the procedure is not sufficiently enhanced, in my opinion, to counterbalance the real added risks of cautery in this application. G. B. Perlstein, M.D. Champaign, Illinois 61820
UROLOGY / JULY1932 / VOLUMEXX,NUMBERl
FOR CONTINUOUS
To the Editor: I read with much interest the article by P. M. Livne et al., “Simple Method of Continuous Bladder Irrigation for Prevention of Postprostatectomy Complications,” published in the March (vol. 19, pages 314-315, 1982) of UROLOGY. I endorse their use of a twocatheter system for bladder irrigation; I always have thought that the continuous irrigation catheters commercially available have the disadvantage of a decreased outflow lumen. However, I wish to propose an even simpler method which has had good success, and with widei application. Livne et al. advocate the use of a whistletip catheter. In insuring against postprostatectomy complications, I think it is imperative to use a catheter which can supply traction. Accordingly, I use a 24-F, 30-cc balloon Foley catheter. My inflow is provided through the peripheral central venous pressure (CVP) line supplied with a 14- or 16-gauge needle. The needle permits oblique insertion into the catheter lumen opposite the balloon inflow valve (Fig. 1). The CVP line is then passed so that it exits from the eye. The stylet is then removed. and the metal wire is severed from the plastic cap, The CVP line is then cut, leaving enough
FIGURE catheter through
110
1.
Needle of CVP obliquely stylet allows easy advancement catheter lumen.
inserted; of line
FIGURE 2. Complete continuous irrigation system, note amount of CVP line exiting .from catheter eyra. and plastic guard as good aid .for proper tethering to thigh.
through the eye so that it can be bent back to allow smooth passage into the bladder. The plastic cap is retained to use as a sterile barrier when the inflow line is not in use. Irrigation is supplied through a simple intravenous line. The plastic guard which is provided for the protection of the CVP line as it passes through the cutting end of the insertion needle allows for good tethering to the leg (Fig. 2). When no longer necessary, the CVP line can be withdrawn easily: from the catheter, the oblique angle of entry preventing any- leakage of fluid. This simple system can be used in any situation requiring continuous bladder irrigation, does not require side by side catheters. and does not need suture materials or tape on the catheter. David Jay Caro, M.D. 100 NE Randolph Peoria, Illinois 61604 ELECTROCAUTERY
CIRCUMCISION
To the Editor: I was dismayed to note A. Barry Belman’s article, “Electrocautery Circumcision,” published in the November issue (vol. 18, pages 506-507, 1981) of UROLOGY, and especially the absence of editorial caveat. I cannot give the citations, but I know that there has been at least one disastrous complication of circumcision by cautery, resulting in substantial penile loss for the patient, and monetary gain for his lawyer. As I recall, this also involved the use of a Gomco clamp, which is not part of Dr. Belman’s technique. The facility of the procedure is not sufficiently enhanced, in my opinion, to counterbalance the real added risks of cautery in this application. G. B. Perlstein, M.D. Champaign, Illinois 61820
UROLOGY / JULY1932 / VOLUMEXX,NUMBERl