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Perineal repair of urethral strictures with skin graft patch
FILM AND BOOK REVIEWS
FILMS
by Stuart
Levey
Treatment of Erectile Impotence with an Inflatable Prosthesis F. Brantley Scott, William Bradley, and Gerald Timm This interesting film shows a novel device consisting of a mechanically inflatable and deflatable silicone cylinder connected by tubing to an actuator and water reservoir, enabling an impotent male to attain an erection at will. The mechanism is similar to the author’s incontinence device. A description of the surgical implantation of this unique device is given; however, the technical aspects of the prosthesis were not clearly described. It appears that the dissection to the corpora cavernosa can be difficult and is a partially blind technique using a specially constructed Metzenbaum scissors. Once perfected and simplified, this prosthesis could be implanted into impotent men and permit a more “normal” erection than those obtained with the more rigid prostheses currently in use.
Perineal Repair of Urethral Strictures with Skin Graft Patch Charles J. Devine, Jr., and Patrick C. Devine This film demonstrates the surgical repair of urethral strictures through a perineal incision. Prior to the incision, methylene blue is placed in the urethra and affords easy identification of the strictured area once the urethra is opened. The stricture is completely excised and a full-thickness skin graft from the penile shaft near the corona is used to bridge the gap. The skin side of the graft is placed so that it faces the urethral lumen. The photography in parts was of poor quality; the depths of the incision could not be seen at times. However, the narrative portion was excellent and the technique appears useful as a good one-stage repair of bulbous urethral strictures in selected cases.
Renal Autotransplantation and Extracorporeal Surgery Carl A. Olsson This movie demonstrates the salvageability of a kidney apparently destined for nephrectomy. The author employed a combination of extracorporeal surgery with a pulsatile perfusion pump to prepare a kidney and ureter already operated on several
400
times for autotransplantation. Because of a very short ureter, a Boari flap was fashioned to bridge the gap between the ureter and bladder. The postoperative urogram showed good renal function. The author has shown that in a select group of patients aggressive surgical attempts can be made to preserve renal function, and by the use of already established urologic procedures, a good result can be obtained.
BOOKS Glomerulonephritis - Morphology, Natural History and Treatment, Proceedings of an International Symposium, Royal Melbourne Hospital, by Priscilla T. H. Mathew, and E. Love11 Becker, Kin&d-Smith, Eds., New York, John Wiley & Sons, 1973, Parts 1 and 2, 1238 pages, $45.00. One need only examine the roster of diagnoses applied to any group of patients sustained by hemodialysis or subjected to renal transplantation to underscore the importance of glomerulonephritis which accounts for about 50 per cent of renal failure throughout Europe and the United States. In 1948 glomerulonephritis was viewed by Addis as “. . . a unique disease that cannot be mistaken for any other . . .” with orderly progression from an acute form into a “degenerative terminal stage.” The introduction of percutaneous renal biopsy by Claus Brun in the early 1950s and immunofluorescence and electron microscopic study of fresh biopsy material throughout the 1960s has so expanded our data base that 37 investigators identified with significant contributions to the field were able to hold a working conference in 1972 necessitating a two-volume text weighing 2.8 Kg. to contain its proceedings. As noted in the foreword by Hamburger, the book is (was) timely and “. . . will, undoubtedly become a reference for all nephrologists.” Of greatest value are the tabulations of frequency of various pathologic findings as correlated with clinical course. For example, Habib analyzed 1,368 patients clinically diagnosed as glomerulonephritis and found only minimal glomerular lesions in 586 (43 per cent), nonspecific patterns in 607 (44 per cent), and specific patterns (such as amyloidosis or thrombotic microangiopathy) in only 142 (10 per cent). Churg and Duffy classified their large series (625 cases) of proliferative glomerulonephritis according to the type and severity of glomerular lesion and noted that 50 per cent (60 of 120) of children had acute diffuse changes while only 22 per cent (110 of 505) adults had similar changes. Cameron bravely tried to identify disease syndromes on the basis of clinical expression (acute, nephrotic,
UROLOGY
/ SEPTEMBER
1975 / VOLUME
VI, NUMBER
3
FILMS
by Stuart
Levey
Treatment of Erectile Impotence with an Inflatable Prosthesis F. Brantley Scott, William Bradley, and Gerald Timm This interesting film shows a novel device consisting of a mechanically inflatable and deflatable silicone cylinder connected by tubing to an actuator and water reservoir, enabling an impotent male to attain an erection at will. The mechanism is similar to the author’s incontinence device. A description of the surgical implantation of this unique device is given; however, the technical aspects of the prosthesis were not clearly described. It appears that the dissection to the corpora cavernosa can be difficult and is a partially blind technique using a specially constructed Metzenbaum scissors. Once perfected and simplified, this prosthesis could be implanted into impotent men and permit a more “normal” erection than those obtained with the more rigid prostheses currently in use.
Perineal Repair of Urethral Strictures with Skin Graft Patch Charles J. Devine, Jr., and Patrick C. Devine This film demonstrates the surgical repair of urethral strictures through a perineal incision. Prior to the incision, methylene blue is placed in the urethra and affords easy identification of the strictured area once the urethra is opened. The stricture is completely excised and a full-thickness skin graft from the penile shaft near the corona is used to bridge the gap. The skin side of the graft is placed so that it faces the urethral lumen. The photography in parts was of poor quality; the depths of the incision could not be seen at times. However, the narrative portion was excellent and the technique appears useful as a good one-stage repair of bulbous urethral strictures in selected cases.
Renal Autotransplantation and Extracorporeal Surgery Carl A. Olsson This movie demonstrates the salvageability of a kidney apparently destined for nephrectomy. The author employed a combination of extracorporeal surgery with a pulsatile perfusion pump to prepare a kidney and ureter already operated on several
400
times for autotransplantation. Because of a very short ureter, a Boari flap was fashioned to bridge the gap between the ureter and bladder. The postoperative urogram showed good renal function. The author has shown that in a select group of patients aggressive surgical attempts can be made to preserve renal function, and by the use of already established urologic procedures, a good result can be obtained.
BOOKS Glomerulonephritis - Morphology, Natural History and Treatment, Proceedings of an International Symposium, Royal Melbourne Hospital, by Priscilla T. H. Mathew, and E. Love11 Becker, Kin&d-Smith, Eds., New York, John Wiley & Sons, 1973, Parts 1 and 2, 1238 pages, $45.00. One need only examine the roster of diagnoses applied to any group of patients sustained by hemodialysis or subjected to renal transplantation to underscore the importance of glomerulonephritis which accounts for about 50 per cent of renal failure throughout Europe and the United States. In 1948 glomerulonephritis was viewed by Addis as “. . . a unique disease that cannot be mistaken for any other . . .” with orderly progression from an acute form into a “degenerative terminal stage.” The introduction of percutaneous renal biopsy by Claus Brun in the early 1950s and immunofluorescence and electron microscopic study of fresh biopsy material throughout the 1960s has so expanded our data base that 37 investigators identified with significant contributions to the field were able to hold a working conference in 1972 necessitating a two-volume text weighing 2.8 Kg. to contain its proceedings. As noted in the foreword by Hamburger, the book is (was) timely and “. . . will, undoubtedly become a reference for all nephrologists.” Of greatest value are the tabulations of frequency of various pathologic findings as correlated with clinical course. For example, Habib analyzed 1,368 patients clinically diagnosed as glomerulonephritis and found only minimal glomerular lesions in 586 (43 per cent), nonspecific patterns in 607 (44 per cent), and specific patterns (such as amyloidosis or thrombotic microangiopathy) in only 142 (10 per cent). Churg and Duffy classified their large series (625 cases) of proliferative glomerulonephritis according to the type and severity of glomerular lesion and noted that 50 per cent (60 of 120) of children had acute diffuse changes while only 22 per cent (110 of 505) adults had similar changes. Cameron bravely tried to identify disease syndromes on the basis of clinical expression (acute, nephrotic,
UROLOGY
/ SEPTEMBER
1975 / VOLUME
VI, NUMBER
3