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RE: INFLUENCE OF TECHNIQUE OF PERCUTANEOUS TRACT CREATION ON INCIDENCE OF RENAL HEMORRHAGE
0022-5347B8ll604-1438%03.0Q/O
Vol. 160,1438-1444,October 1998
Tm:JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright 0 1998 by AMEMCM URO~~CICAL ASSOCIA~ON, INC.
Letters to the Editor RE: INFLUENCE OF TECHNIQUE OF PERCUTANEOUS TRACT CREATION ON INCIDENCE OF RENAL HEMORRHAGE R. Davidoff and G. C. Bellman
J. Urol., 157: 1229, 1997
To the Editor. I read this article with interest. Davidoff and Bellman propose that balloon dilation has distinct advantages for any percutaneous renal procedure. Compared to sequential Amplatz dilators, the incidence of bleeding and other tract related complications is much less. With my limited experience with balloon dilation I tend to agree. Although safe, balloons for tract dilation are expensive. To circumvent excessive cost while maintaining safety we implement a few minor precautions to help decrease the need for blood transfusion. Telescopic Alken dilators are normally available in a set of 7 up to 27F. Using an additional 30F dilator, which is available separately, bleeding may be significantly minimized. An Amplatz sheath may be slid directly over the 30F dilator. These dilators are easy to sterilize and long lasting, hence they are affodable in the long term. Dilation is restricted to the minimum necessary. In a nondilated system it is restricted to 28F, while in others I dilate to 30F. I never dilate more than 30F in the kidney, which also helps to decrease the complications related to dilation. In addition, autologous blood transfusion helps to decrease complications related to transfusion. Respectfully, Pankaj N. Maheshwari R. G. Stone Urological Research Institute 14-A Road, Khar-W Mumbai-52 India
1. Gerharz, E. W., Tassadaq, T., Pickard, R. S., Shah, J. R., Woodhouse, C. R. J. and Ransley, P. G.: Transverse retubularized ileum: early clinical experience with a new second line Mitrofanoff tube. J. Urol., 1 5 9 525, 1998. 2. Monti, P. R., Lara, R. C., Dutra, M. A. and De Cayalho, J. R.: New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology, 4 9 112, 1997. 3. Yang, W. -H.: Yang needle tunneling techni ue in creating antireflux and continent mechanisms. J. Uro?., 1 5 0 830, 1993.
Reply by Author. In that article Yang also described tubularization of a short transverse segment of small bowel to create a catheterizable channel (reference 3 in Letter). The thrust of this article was on the tunneling technique but creation of a tapered catheterizable small bowel segment was clearly described and published 3 years before the report of Monti et a1 (reference 2 in Letter), proving again that little is new except our understanding.
RE: TESTICULAR DESCENT: A PROPOSED INTERACTION BETWEEN m L E R I A N INHIBITING SUBSTANCE AND EPIDERMAL GROWTH FACTOR
Y. Siow and M. E. Fallat J. Urol., 1 5 8 613-614, 1997
To the Editor. Siow and Fallat present some intriguing ideas about the possible roles of miillerian inhibiting substance and epidermal growth factor in testicular descent but they fail to cite a number of studies that do not support their theories. They propose that the lack of cryptorchidism in rabbit fetuses exposed to miillerian inhibiting Reply by Authors. It is difficultto argue that reusable instruments are substance antibody in the experiment of Tran et all may be attribmore affordablethan disposable products. However, the objective of our uted to decreased serum miillerian inhibiting substance, which purstudy was to study the incidenceof hemorrhage in the 2 types of dilating portedly leads to increases in epidermal growth factor receptor acsystems. Alken and Amplatz dilators are similar conceptually in the tivity, placental gonadotropin production and serum testosterone method of tract dilation. While we have not studied the incidence of levels, in that order. This finding seems unlikely since in the normal bleedmg using Alken dilators, one may theorize that it would be similar male rabbit fetus the surge in serum testosterone is already maximal to that of Amplatz dilators. The use of a reusable balloon system would and it does not appear to depend on gonadotropin stimulation.2 Moreover, the fact that transgenic mice lacking miillerian inhibiting theoretically be affordable and associated with less bleeding. substance or miillerian inhibiting substance receptor have descended t e ~ t e s 3further ,~ supports the conclusion of Tran et al that mullerian inhibiting substance does not stimulate testicular descent.' Siow and Fallat go on to suggest that the physiological role of RE: EDITORIAL: ALTERNATIVES TO APPENDIX IN miillerian inhibiting substance in testicular descent may actually be CONSTRUCTION inhibitory. The observation that high serum levels persist until the OF A MITROFANOFF STOMA third trimester, and decrease coincident with regression of the gubernaculum and scrotal descent of the human testis certainly supM. E. Mitchell ports this theory. Furthermore, Behringels and Lyet'j et a1 have J. Urol., 159: 529, 1998 shown that excess miillerian inhibiting substance causes cryptorchidism, hypospadias and impaired Leydig cell steroidogenesis in To the Editor. Mitchell states that the technique of a good retubu- transgenic mice. Siow and Fallat seem to suggest that miillerian larized ileum with a mesentery-free tube for reimplantation and inhibiting substance suppresses androgen production during mid creation of a catheterizable stoma was not developed by Gerharz et gestation by inhibiting epidermal growth factor receptor dependent all but described in 1997 by Monti et a1.2 However, it should be gonadotropin release by the placenta. Yet in the first trimester recognized that the first urologist who described this really useful serum testosterone reaches pubertal levels and human chorionic technique was Yang from Taiwan, who reported the procedure in gonadotropin is high even when miillerian inhibiting substance pro1993 with a detailed description in figure 3.3 Unfortunately the duction is high. Later in gestation fetal luteinizing hormone stimuarticle by Yang was never mentioned. lates testosterone production. A more likely mechanism of putative Respectfully. miillerian inhibiting substance inhibition of testicular descent that is Stephan Roth not discussed by Siow and Fallat is inhibition of the epidermal Department of Urology and Pediatric Urology growth factor receptor at the end organ. Gupta et a1 have shown that University of Witten JHerdecke. Klinikurn Wuppertal epidermal growth factor directly masculinizes the fetal male genital Heusnerstr. 40 tract in the absence of androgen via an androgen receptor dependent 42283 Wuppertal mechanism.7 Germany Since regression of the gubernaculum seems to be mediated by 1438
Vol. 160,1438-1444,October 1998
Tm:JOURNAL OF UROLOGY
Printed in U.S.A.
Copyright 0 1998 by AMEMCM URO~~CICAL ASSOCIA~ON, INC.
Letters to the Editor RE: INFLUENCE OF TECHNIQUE OF PERCUTANEOUS TRACT CREATION ON INCIDENCE OF RENAL HEMORRHAGE R. Davidoff and G. C. Bellman
J. Urol., 157: 1229, 1997
To the Editor. I read this article with interest. Davidoff and Bellman propose that balloon dilation has distinct advantages for any percutaneous renal procedure. Compared to sequential Amplatz dilators, the incidence of bleeding and other tract related complications is much less. With my limited experience with balloon dilation I tend to agree. Although safe, balloons for tract dilation are expensive. To circumvent excessive cost while maintaining safety we implement a few minor precautions to help decrease the need for blood transfusion. Telescopic Alken dilators are normally available in a set of 7 up to 27F. Using an additional 30F dilator, which is available separately, bleeding may be significantly minimized. An Amplatz sheath may be slid directly over the 30F dilator. These dilators are easy to sterilize and long lasting, hence they are affodable in the long term. Dilation is restricted to the minimum necessary. In a nondilated system it is restricted to 28F, while in others I dilate to 30F. I never dilate more than 30F in the kidney, which also helps to decrease the complications related to dilation. In addition, autologous blood transfusion helps to decrease complications related to transfusion. Respectfully, Pankaj N. Maheshwari R. G. Stone Urological Research Institute 14-A Road, Khar-W Mumbai-52 India
1. Gerharz, E. W., Tassadaq, T., Pickard, R. S., Shah, J. R., Woodhouse, C. R. J. and Ransley, P. G.: Transverse retubularized ileum: early clinical experience with a new second line Mitrofanoff tube. J. Urol., 1 5 9 525, 1998. 2. Monti, P. R., Lara, R. C., Dutra, M. A. and De Cayalho, J. R.: New techniques for construction of efferent conduits based on the Mitrofanoff principle. Urology, 4 9 112, 1997. 3. Yang, W. -H.: Yang needle tunneling techni ue in creating antireflux and continent mechanisms. J. Uro?., 1 5 0 830, 1993.
Reply by Author. In that article Yang also described tubularization of a short transverse segment of small bowel to create a catheterizable channel (reference 3 in Letter). The thrust of this article was on the tunneling technique but creation of a tapered catheterizable small bowel segment was clearly described and published 3 years before the report of Monti et a1 (reference 2 in Letter), proving again that little is new except our understanding.
RE: TESTICULAR DESCENT: A PROPOSED INTERACTION BETWEEN m L E R I A N INHIBITING SUBSTANCE AND EPIDERMAL GROWTH FACTOR
Y. Siow and M. E. Fallat J. Urol., 1 5 8 613-614, 1997
To the Editor. Siow and Fallat present some intriguing ideas about the possible roles of miillerian inhibiting substance and epidermal growth factor in testicular descent but they fail to cite a number of studies that do not support their theories. They propose that the lack of cryptorchidism in rabbit fetuses exposed to miillerian inhibiting Reply by Authors. It is difficultto argue that reusable instruments are substance antibody in the experiment of Tran et all may be attribmore affordablethan disposable products. However, the objective of our uted to decreased serum miillerian inhibiting substance, which purstudy was to study the incidenceof hemorrhage in the 2 types of dilating portedly leads to increases in epidermal growth factor receptor acsystems. Alken and Amplatz dilators are similar conceptually in the tivity, placental gonadotropin production and serum testosterone method of tract dilation. While we have not studied the incidence of levels, in that order. This finding seems unlikely since in the normal bleedmg using Alken dilators, one may theorize that it would be similar male rabbit fetus the surge in serum testosterone is already maximal to that of Amplatz dilators. The use of a reusable balloon system would and it does not appear to depend on gonadotropin stimulation.2 Moreover, the fact that transgenic mice lacking miillerian inhibiting theoretically be affordable and associated with less bleeding. substance or miillerian inhibiting substance receptor have descended t e ~ t e s 3further ,~ supports the conclusion of Tran et al that mullerian inhibiting substance does not stimulate testicular descent.' Siow and Fallat go on to suggest that the physiological role of RE: EDITORIAL: ALTERNATIVES TO APPENDIX IN miillerian inhibiting substance in testicular descent may actually be CONSTRUCTION inhibitory. The observation that high serum levels persist until the OF A MITROFANOFF STOMA third trimester, and decrease coincident with regression of the gubernaculum and scrotal descent of the human testis certainly supM. E. Mitchell ports this theory. Furthermore, Behringels and Lyet'j et a1 have J. Urol., 159: 529, 1998 shown that excess miillerian inhibiting substance causes cryptorchidism, hypospadias and impaired Leydig cell steroidogenesis in To the Editor. Mitchell states that the technique of a good retubu- transgenic mice. Siow and Fallat seem to suggest that miillerian larized ileum with a mesentery-free tube for reimplantation and inhibiting substance suppresses androgen production during mid creation of a catheterizable stoma was not developed by Gerharz et gestation by inhibiting epidermal growth factor receptor dependent all but described in 1997 by Monti et a1.2 However, it should be gonadotropin release by the placenta. Yet in the first trimester recognized that the first urologist who described this really useful serum testosterone reaches pubertal levels and human chorionic technique was Yang from Taiwan, who reported the procedure in gonadotropin is high even when miillerian inhibiting substance pro1993 with a detailed description in figure 3.3 Unfortunately the duction is high. Later in gestation fetal luteinizing hormone stimuarticle by Yang was never mentioned. lates testosterone production. A more likely mechanism of putative Respectfully. miillerian inhibiting substance inhibition of testicular descent that is Stephan Roth not discussed by Siow and Fallat is inhibition of the epidermal Department of Urology and Pediatric Urology growth factor receptor at the end organ. Gupta et a1 have shown that University of Witten JHerdecke. Klinikurn Wuppertal epidermal growth factor directly masculinizes the fetal male genital Heusnerstr. 40 tract in the absence of androgen via an androgen receptor dependent 42283 Wuppertal mechanism.7 Germany Since regression of the gubernaculum seems to be mediated by 1438