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Technique for Transurethral Removal of Ureteral Calculi by Constant Traction
THE JOURNAL OF UROLOGY
Vol. 64, No. 6, December 1950 Printed in U.S.A.
TECHNIQUE FOR TRANSURETHRAL REMOVAL OF URETERAL CALCULI BY CONSTANT TRACTION HJALMAR E. CARLSON
vVhen a calculus or calculi have once become enmeshed in any of the various baskets, it is not always possible to withdraw the basket at the time of operation. Intermittent or continued traction by one means or another is then used until the basket and its contents are removed. To this end we have made use of the following method. A large plastic washer with a small hole is slipped over the wire and snugged up against the head of the penis. The locking handle of the instrument is then
F~G. 1. Accordion-like pleats in penis arc produced by tightening handle of instrnment against plastic washer.
tightened against the washer. To provide sufficient traction there must be one or more accordion-like pleats in the penis to provide sufficient tissue turgor. Traction is further increased by the intermittent contractions of the levator ani muscles. Erections do not appear to occur during the length of time the instrument is in place; however, we would hesitate to say that erections could not be troublesome in some individuals, and if such erections occur tension must be relaxed and when erection has ceased tension is again applied. Voiding is accomplished in the erect position. Because of a minimum of attachments the patient is able to get out of bed himself to accomplish the act. Since most calculi enmeshed in baskets occur in younger men they are usually able to see and understand the mechanics of the device. They can be taught to loosen the handle, void and retighten it. Other individuals, of course, may need assistance. Frequent check-ups, hmvever, by the hospital staff should be made, and at this time slow, continued manual traction for a period of .5 minutes is applied. 1816 Professional Bldg., Kansas City, Nfo. 736
Vol. 64, No. 6, December 1950 Printed in U.S.A.
TECHNIQUE FOR TRANSURETHRAL REMOVAL OF URETERAL CALCULI BY CONSTANT TRACTION HJALMAR E. CARLSON
vVhen a calculus or calculi have once become enmeshed in any of the various baskets, it is not always possible to withdraw the basket at the time of operation. Intermittent or continued traction by one means or another is then used until the basket and its contents are removed. To this end we have made use of the following method. A large plastic washer with a small hole is slipped over the wire and snugged up against the head of the penis. The locking handle of the instrument is then
F~G. 1. Accordion-like pleats in penis arc produced by tightening handle of instrnment against plastic washer.
tightened against the washer. To provide sufficient traction there must be one or more accordion-like pleats in the penis to provide sufficient tissue turgor. Traction is further increased by the intermittent contractions of the levator ani muscles. Erections do not appear to occur during the length of time the instrument is in place; however, we would hesitate to say that erections could not be troublesome in some individuals, and if such erections occur tension must be relaxed and when erection has ceased tension is again applied. Voiding is accomplished in the erect position. Because of a minimum of attachments the patient is able to get out of bed himself to accomplish the act. Since most calculi enmeshed in baskets occur in younger men they are usually able to see and understand the mechanics of the device. They can be taught to loosen the handle, void and retighten it. Other individuals, of course, may need assistance. Frequent check-ups, hmvever, by the hospital staff should be made, and at this time slow, continued manual traction for a period of .5 minutes is applied. 1816 Professional Bldg., Kansas City, Nfo. 736