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Foreign Body Retrieval
THE JOURNAL OF UROLOGY
Copyrig-ht © 1976 by The Williams & Wilkins Co.
Letters to the Editor FOREIGN BODY RETRIEVAL
To the Editor. The endless variety of objects that men and women insert into the bladder continues to be a subject for amazement to all urologists. In addition, however, is the problem of how to get rid of these foreign bodies and the inevitable infection that they cause. Especially troublesome are floating bodies, since none of our instruments is made to work easily in the dome of the bladder. I discovered a trick of the trade when a young man with cystitis was found to have a partially calcified empty ink cartridge in the bladder. Repeated attempts using grasping forceps, biopsy forceps and so forth were unsuccessful until the bladder was half filled with air with a sphygmomanometer bulb. It was then easy to manipulate the cartridge into the end of the resectoscope and to remove it. The same technique worked well in retrieving a piece of Foley catheter bag during office cystoscopy. In the first case infection cleared quickly. The post-prostatectomy infection was more stubborn to clear in the second case but this patient also is now fine. Perhaps this technique will be helpful to others in the future. Respectfully, C. Balcom Moore 20 E. Birch Street Walla Walla, Washington
tally another possible complication is infection of any degree. A broadspectrum antibiotic given 1 day before and 3 to 4 days after the procedure may minimize a possible infection. Bleeding after needle biopsy usually drains into the bladder. For this reason, the patient is asked not to void for at least 3 hours before the biopsy but to empty the bladder immediately afterwards. If frank bleeding is present the patient is asked to void again in 1 hour. If bleeding is subsiding the patient is allowed to leave the office. If bleeding persists the patient must remain under observation. Severe bleeding was controlled in 4 cases: 2 by endoscopic fulguration of_the ble~ding points in the posterior urethra and 2 with the 3-way mdwellmg Foley catheter and continuous irrigation. To prevent possible injury to the urethra, especially when a prostatic nodule is in a medial location, the patient is placed in the lithotomy position and a 20F curved metal sound is inserted in the urethra. The rectal finger can, thus, establish the exact relationship between the prostatic urethra and the prostatic nodule to be biopsied. The presence of the metal sound also prevents penetration of the biopsy needle into the prostatic urethra. In cases in which cystoscopy and prostatic needle biopsy are performed during the same session the cystoscope is substituting for the sound. With this described technique no intraurethral bleeding has been encountered in the last 46 biopsy cases.
PROSTATIC NEEDLE BIOPSY UNDER CONTROL OF A METAL URETHRAL SOUND
To the Editor. A possible dangerous complication after a prostatic needle biopsy is hemorrhage. When the biopsy is performed transrec-
535
Respectfully, A. M. B. Goldstein University of Southern California Medical Center Los Angeles, California
Copyrig-ht © 1976 by The Williams & Wilkins Co.
Letters to the Editor FOREIGN BODY RETRIEVAL
To the Editor. The endless variety of objects that men and women insert into the bladder continues to be a subject for amazement to all urologists. In addition, however, is the problem of how to get rid of these foreign bodies and the inevitable infection that they cause. Especially troublesome are floating bodies, since none of our instruments is made to work easily in the dome of the bladder. I discovered a trick of the trade when a young man with cystitis was found to have a partially calcified empty ink cartridge in the bladder. Repeated attempts using grasping forceps, biopsy forceps and so forth were unsuccessful until the bladder was half filled with air with a sphygmomanometer bulb. It was then easy to manipulate the cartridge into the end of the resectoscope and to remove it. The same technique worked well in retrieving a piece of Foley catheter bag during office cystoscopy. In the first case infection cleared quickly. The post-prostatectomy infection was more stubborn to clear in the second case but this patient also is now fine. Perhaps this technique will be helpful to others in the future. Respectfully, C. Balcom Moore 20 E. Birch Street Walla Walla, Washington
tally another possible complication is infection of any degree. A broadspectrum antibiotic given 1 day before and 3 to 4 days after the procedure may minimize a possible infection. Bleeding after needle biopsy usually drains into the bladder. For this reason, the patient is asked not to void for at least 3 hours before the biopsy but to empty the bladder immediately afterwards. If frank bleeding is present the patient is asked to void again in 1 hour. If bleeding is subsiding the patient is allowed to leave the office. If bleeding persists the patient must remain under observation. Severe bleeding was controlled in 4 cases: 2 by endoscopic fulguration of_the ble~ding points in the posterior urethra and 2 with the 3-way mdwellmg Foley catheter and continuous irrigation. To prevent possible injury to the urethra, especially when a prostatic nodule is in a medial location, the patient is placed in the lithotomy position and a 20F curved metal sound is inserted in the urethra. The rectal finger can, thus, establish the exact relationship between the prostatic urethra and the prostatic nodule to be biopsied. The presence of the metal sound also prevents penetration of the biopsy needle into the prostatic urethra. In cases in which cystoscopy and prostatic needle biopsy are performed during the same session the cystoscope is substituting for the sound. With this described technique no intraurethral bleeding has been encountered in the last 46 biopsy cases.
PROSTATIC NEEDLE BIOPSY UNDER CONTROL OF A METAL URETHRAL SOUND
To the Editor. A possible dangerous complication after a prostatic needle biopsy is hemorrhage. When the biopsy is performed transrec-
535
Respectfully, A. M. B. Goldstein University of Southern California Medical Center Los Angeles, California