- Email: [email protected]
New method of cystourethrography
SURGEON’S
NEW
METHOD
HOSSEIN
GOLJI,
WORKSHOP
OF CYSTOURETHROGRAPHY M.D.
From the Spinal Cord Injury Service, Veterans Administration Hospital, Long Beach, and Department of Surgery, Division Urology, University of California (Irvine), California
Materials
Urologists and radiologists have used retrograde cystourethrography, with radiopaque media and/or with gas, as a routine diagnostic procedure in patients with spinal cord injury for years. The diagnostic values and interpretation of cystourethrograms are well established; but the method of performance still is different in each institution, and the fear of radiation hazard to the technicians is ever-growing.
of
and Method
1. Urethrography set includes a Brodny a 50-cc. syringe for infusion of clamp, and a 3-way connector radiopaque medium, (Fig. 1). 2. Safety pressure valve* is a miniature pressure relief valve (Fig. 2A), made of stainless steel body with an inner spring (Fig. 2B, C) giv-
FIGURE 1. Urethrography set: Brodny clamp, 50-cc. syringe, and S-way connector.
Herein a new method is presented which gives uniform and reproducible results, provides control over the infusion pressure for prevention of trauma, and offers radiation protection to the technicians. There is no intention to compare the values and the results with voiding cystourethrography.
ing way to a minimum water. The sealing part Teflon (Fig. 2D). 3. Infusion pump is infant feeding syringe
a modification pump made
*P.T.E.
California.
UROLOGY
6
/
DECEMBER
1979
/
VOLUME
XIV,
NUMBER
Company,
Los Angeles,
pressure of 150 cm. of of the valve is made of of Raze1 by Raze1
605
B
A Inner
C
Spring
Tef loySeal--9_
‘,,-I/
D
FIGURE 2. (A and B) Miniature pressure of stainless steel with inner spring (C) sealing (D).
FIGURE 3. (A,B,C) Infusion pump with motor propels ;l( driven shaft pressure backing of car&age (D) for&&d at 5 cm. /min.
606
r-c lief valve a,~d Tejon
Scientific Institute (Fig. 3A,B,C). The motordriven shaft of the pump propels the pressure backing of carriage (D) forward at 5 cm./min. After preparing and draping the patient, in supine and 30-45” oblique position, attach the 3-way connector to Brodny clamp, the syringe through the 3-way stopcock, and the safety valve to prime them with radiopaque medium and to rid the system of the dead air (Fig. 4A, B). Place and secure Brodny clamp to the urethral meatus, refill the syringe through the veno pack attached to the reservoir of dye, and place the syringe on the cradle (Fig. 4C). When the infusion pump starts, the plunger of the syringe is driven forward with a speed of 5 cm./minute. The radiopaque medium is injected into the urethra, and the resistance of the urethra is transmitted to the safety pressure valve (Fig. 4C). The technician proceeds to the control room where he observes the syringe, the pump, and the amount of dye in the syringe. With a SO-cc. Luerlock syringe the velocity of infusion by the pump would be about 20 cc./min. When about 20 to 30 cc. of radiopaque medium are injected, the x-ray films are taken (Fig. 5). The technician
.I zp!!q .3-f;; i
:: 1
UROLOGY
i
DECEMBER
1979
/
VOLUME
XIV,
NUMBER
6
FIGURE 4. C ystourethrography method: (A) attach S-way connector to Brodny clamp; (B) syringe through S-way stopcock ant; safety valve; (C) syringe on cradle.
FIGURE 5. (A to D) jilms taken after 20 to 30 cc. of radiopayue medium injected.
X-ray
UROLOGY / DECEMBER1979 / VOLUMEXIV, NUMBER6
607
then stops the pump until the films are reviewed. The syringe may be refilled if necessary, and the procedure can be repeated without disturbing the setup. If the urethral sphincter is very spastic, causing a rise in the intraurethral pressure above 150 cm. of water, the safety pressure valve responds and lets the radiopaque medium out of the urethra to prevent extravasation or rupture. Simultaneous recording of urethral sphincter and anterior urethral pressures has shown the tolerance of the urethra to stretch up to 250 cm.
608
of water pressure and the capacity of the anterior urethra up to 60 cc. At our Center, this method of retrograde urethrography has been used in more than 1,000 cases with informative, reproducible, and uniform results. It is atraumatic to the patients and protective to the technicians who are reluctant to remain in the room with the patients because of radiation hazards. 5901 East 7th Street Long Beach, California 90822
UROLOGY
/ DECEMBER1979
/ VOLUMEXJV,
NUMBER6
NEW
METHOD
HOSSEIN
GOLJI,
WORKSHOP
OF CYSTOURETHROGRAPHY M.D.
From the Spinal Cord Injury Service, Veterans Administration Hospital, Long Beach, and Department of Surgery, Division Urology, University of California (Irvine), California
Materials
Urologists and radiologists have used retrograde cystourethrography, with radiopaque media and/or with gas, as a routine diagnostic procedure in patients with spinal cord injury for years. The diagnostic values and interpretation of cystourethrograms are well established; but the method of performance still is different in each institution, and the fear of radiation hazard to the technicians is ever-growing.
of
and Method
1. Urethrography set includes a Brodny a 50-cc. syringe for infusion of clamp, and a 3-way connector radiopaque medium, (Fig. 1). 2. Safety pressure valve* is a miniature pressure relief valve (Fig. 2A), made of stainless steel body with an inner spring (Fig. 2B, C) giv-
FIGURE 1. Urethrography set: Brodny clamp, 50-cc. syringe, and S-way connector.
Herein a new method is presented which gives uniform and reproducible results, provides control over the infusion pressure for prevention of trauma, and offers radiation protection to the technicians. There is no intention to compare the values and the results with voiding cystourethrography.
ing way to a minimum water. The sealing part Teflon (Fig. 2D). 3. Infusion pump is infant feeding syringe
a modification pump made
*P.T.E.
California.
UROLOGY
6
/
DECEMBER
1979
/
VOLUME
XIV,
NUMBER
Company,
Los Angeles,
pressure of 150 cm. of of the valve is made of of Raze1 by Raze1
605
B
A Inner
C
Spring
Tef loySeal--9_
‘,,-I/
D
FIGURE 2. (A and B) Miniature pressure of stainless steel with inner spring (C) sealing (D).
FIGURE 3. (A,B,C) Infusion pump with motor propels ;l( driven shaft pressure backing of car&age (D) for&&d at 5 cm. /min.
606
r-c lief valve a,~d Tejon
Scientific Institute (Fig. 3A,B,C). The motordriven shaft of the pump propels the pressure backing of carriage (D) forward at 5 cm./min. After preparing and draping the patient, in supine and 30-45” oblique position, attach the 3-way connector to Brodny clamp, the syringe through the 3-way stopcock, and the safety valve to prime them with radiopaque medium and to rid the system of the dead air (Fig. 4A, B). Place and secure Brodny clamp to the urethral meatus, refill the syringe through the veno pack attached to the reservoir of dye, and place the syringe on the cradle (Fig. 4C). When the infusion pump starts, the plunger of the syringe is driven forward with a speed of 5 cm./minute. The radiopaque medium is injected into the urethra, and the resistance of the urethra is transmitted to the safety pressure valve (Fig. 4C). The technician proceeds to the control room where he observes the syringe, the pump, and the amount of dye in the syringe. With a SO-cc. Luerlock syringe the velocity of infusion by the pump would be about 20 cc./min. When about 20 to 30 cc. of radiopaque medium are injected, the x-ray films are taken (Fig. 5). The technician
.I zp!!q .3-f;; i
:: 1
UROLOGY
i
DECEMBER
1979
/
VOLUME
XIV,
NUMBER
6
FIGURE 4. C ystourethrography method: (A) attach S-way connector to Brodny clamp; (B) syringe through S-way stopcock ant; safety valve; (C) syringe on cradle.
FIGURE 5. (A to D) jilms taken after 20 to 30 cc. of radiopayue medium injected.
X-ray
UROLOGY / DECEMBER1979 / VOLUMEXIV, NUMBER6
607
then stops the pump until the films are reviewed. The syringe may be refilled if necessary, and the procedure can be repeated without disturbing the setup. If the urethral sphincter is very spastic, causing a rise in the intraurethral pressure above 150 cm. of water, the safety pressure valve responds and lets the radiopaque medium out of the urethra to prevent extravasation or rupture. Simultaneous recording of urethral sphincter and anterior urethral pressures has shown the tolerance of the urethra to stretch up to 250 cm.
608
of water pressure and the capacity of the anterior urethra up to 60 cc. At our Center, this method of retrograde urethrography has been used in more than 1,000 cases with informative, reproducible, and uniform results. It is atraumatic to the patients and protective to the technicians who are reluctant to remain in the room with the patients because of radiation hazards. 5901 East 7th Street Long Beach, California 90822
UROLOGY
/ DECEMBER1979
/ VOLUMEXJV,
NUMBER6