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The Development of the Resectoscope
Accepted 617
618
PERCUTANEOUS NEP!IROSTOMY AND ADENOCARCINOMA OF THE PROSTATE.
THE DEVELOPMENT OF THE RESECTOSCOPE.
*Robert A. Dowling, *Cesar H, Carrasco, and Richard J, Babaian, Houston TX (Presentation to be made by Dr. Dowling) Between 1980 and 1985 44 patients with adenocarcinoma of
and Gerald Sufrin, Buffalo·, N.Y. (Presentation to be made by Dr. Szollar.) This presentation traces back the developmental milestones of the most agressive urological instrument: the resectoscope till the age of the Pharaohs. Gallen w:as the first physician who described his attempt to destroy 1t urethral callosities 11 by forceful catheter insertion through the urethra. In the 16th century, inventive French physicians were dominate in pioneering instruments to overcome the blockage in the urethra. (Ambrose Pare, de La Faye, Civiale, Mercier.) In the late 19th century, Enrico Bottini of Pavia was the first to use electric current in transurethral surgery. With the improvement of intravesical visualization the optically controlled excision of obstructive tissue became possible . The different modification of the Young prostatic punch by Kenneth Walker, Braasch and Bumpus were developed further by Stern and Theodore Davies. The McCarthy-designed resectoscope incorporated all the advantages of earlier models. This magnificent instrument had to fight its way through many decades to earn its place in the first row of urological instruments. This instrument was crowned in 1964 by Grayson Caroll (co-author with Bransford Lewis of the famous article: 11 Prostatic Resection Without Moonlight and Roses 11 , ) as being the most outstanding accomplishment in the removal of the prostatic gland.
the prostate underwent percuataneous urinary diversion at M. D. Anderson Hospital. Twenty-two of 31 evaluable patients had failed hormonal therapy at the time ureteral obstruction was documented, and form the basis of this report. The
mean age of the patients was 67 years. The time interval from tumor diagnosis to documentation of ureteral obstruction ranged from 1 to 136 months
(median 25 months). Ob-
struction was unilateral in 5 patients and bilateral in 17 patients. Metastatic disease was documented in 21 of 22 patients at the time of urinary diversion. All 22 patients
were treated with percutaneous nephrostorny tubes in one (16 patients) or both (6 patients) kidneys. Post-nephrostorny therapy consisted of chemotherapy (8 patients), radiation (2 patients), further hormonal manipulation (4 patients), or observation (11 patients)- three of the 11 treated patients received more than one mode of therapy. A separate hospitalization after percutaneous urinary diversion was necessary in 10 patients (45%)- the reasons for hospitalization included therapy, the complications of therapy, and the complications of disease progression. The number of days spent in the hospital ranged from 5 to 118 (mean 44 days), and the number of days spent outside the hospital at last followup ranged from 19 to 1116 (median 139 days) for these 10 patients. Eighteen of 22 patients were dead 15 to 1167 days (median 119 days) after percutaneous urinary diversion, and 14 of 18 patients died iri the hospital. The cause of death was sepsis in 3 patients, cardiac failure in 3 patients, i'enal failure in 2 patients, bowel obstruction in 1 patient, and unspecified in 9 patients. Percutaneous urinary diversion may not improve either the survival or quality of life in patients with hormone refractory adcnocarcinoma of the prostate.
619 A HISTORY OF RENAL VASCULAR SURGERY AT THE CLEVELAND
CLINIC. *Barry H. Bodie, Cleveland, OH (Presentation to be made by Dr. Bodie) The city of Cleveland has long been associated with the surgical treatrrent of hypertension. It was in Cleveland that Harry Goldblatt and Irving Page perfonned their pioneering research in the area of renal vascular hypertension. As a result, IlU.lCh of the early clinical work also took place in this city. Begirming in the early 1950's, Eugene Pontasse working at the Cleveland Clinic, initiated a series of re=nstructive operations for renal artery stenosis using an anterior transperitoneal approach. His efforts were followed in the 1960's by Ralph Straffon and Bruce Stewart, who perfected the technique of aortorenal bypass. Bruce Stewart's landmark paper in 1972 correlating clinical, angiographic, and pathologic findings helped to define the natural history of renal vascular disease. During the late 1970's, the clinic staff began a large experience with ex vivo microsurgical repair of branch renal artery disease followed by autotransplantation. M:Jre recent studies have clarified the role of artherosclerotic renal artery disease as a ==ectable cause of progerssive renal failure. Experience at this institution in over 1000 cases, has provided an opportunity to study many clinical aspects of renal vascular disease and the role of verious treabnent methods.
258A
George P. Szollar'',
618
PERCUTANEOUS NEP!IROSTOMY AND ADENOCARCINOMA OF THE PROSTATE.
THE DEVELOPMENT OF THE RESECTOSCOPE.
*Robert A. Dowling, *Cesar H, Carrasco, and Richard J, Babaian, Houston TX (Presentation to be made by Dr. Dowling) Between 1980 and 1985 44 patients with adenocarcinoma of
and Gerald Sufrin, Buffalo·, N.Y. (Presentation to be made by Dr. Szollar.) This presentation traces back the developmental milestones of the most agressive urological instrument: the resectoscope till the age of the Pharaohs. Gallen w:as the first physician who described his attempt to destroy 1t urethral callosities 11 by forceful catheter insertion through the urethra. In the 16th century, inventive French physicians were dominate in pioneering instruments to overcome the blockage in the urethra. (Ambrose Pare, de La Faye, Civiale, Mercier.) In the late 19th century, Enrico Bottini of Pavia was the first to use electric current in transurethral surgery. With the improvement of intravesical visualization the optically controlled excision of obstructive tissue became possible . The different modification of the Young prostatic punch by Kenneth Walker, Braasch and Bumpus were developed further by Stern and Theodore Davies. The McCarthy-designed resectoscope incorporated all the advantages of earlier models. This magnificent instrument had to fight its way through many decades to earn its place in the first row of urological instruments. This instrument was crowned in 1964 by Grayson Caroll (co-author with Bransford Lewis of the famous article: 11 Prostatic Resection Without Moonlight and Roses 11 , ) as being the most outstanding accomplishment in the removal of the prostatic gland.
the prostate underwent percuataneous urinary diversion at M. D. Anderson Hospital. Twenty-two of 31 evaluable patients had failed hormonal therapy at the time ureteral obstruction was documented, and form the basis of this report. The
mean age of the patients was 67 years. The time interval from tumor diagnosis to documentation of ureteral obstruction ranged from 1 to 136 months
(median 25 months). Ob-
struction was unilateral in 5 patients and bilateral in 17 patients. Metastatic disease was documented in 21 of 22 patients at the time of urinary diversion. All 22 patients
were treated with percutaneous nephrostorny tubes in one (16 patients) or both (6 patients) kidneys. Post-nephrostorny therapy consisted of chemotherapy (8 patients), radiation (2 patients), further hormonal manipulation (4 patients), or observation (11 patients)- three of the 11 treated patients received more than one mode of therapy. A separate hospitalization after percutaneous urinary diversion was necessary in 10 patients (45%)- the reasons for hospitalization included therapy, the complications of therapy, and the complications of disease progression. The number of days spent in the hospital ranged from 5 to 118 (mean 44 days), and the number of days spent outside the hospital at last followup ranged from 19 to 1116 (median 139 days) for these 10 patients. Eighteen of 22 patients were dead 15 to 1167 days (median 119 days) after percutaneous urinary diversion, and 14 of 18 patients died iri the hospital. The cause of death was sepsis in 3 patients, cardiac failure in 3 patients, i'enal failure in 2 patients, bowel obstruction in 1 patient, and unspecified in 9 patients. Percutaneous urinary diversion may not improve either the survival or quality of life in patients with hormone refractory adcnocarcinoma of the prostate.
619 A HISTORY OF RENAL VASCULAR SURGERY AT THE CLEVELAND
CLINIC. *Barry H. Bodie, Cleveland, OH (Presentation to be made by Dr. Bodie) The city of Cleveland has long been associated with the surgical treatrrent of hypertension. It was in Cleveland that Harry Goldblatt and Irving Page perfonned their pioneering research in the area of renal vascular hypertension. As a result, IlU.lCh of the early clinical work also took place in this city. Begirming in the early 1950's, Eugene Pontasse working at the Cleveland Clinic, initiated a series of re=nstructive operations for renal artery stenosis using an anterior transperitoneal approach. His efforts were followed in the 1960's by Ralph Straffon and Bruce Stewart, who perfected the technique of aortorenal bypass. Bruce Stewart's landmark paper in 1972 correlating clinical, angiographic, and pathologic findings helped to define the natural history of renal vascular disease. During the late 1970's, the clinic staff began a large experience with ex vivo microsurgical repair of branch renal artery disease followed by autotransplantation. M:Jre recent studies have clarified the role of artherosclerotic renal artery disease as a ==ectable cause of progerssive renal failure. Experience at this institution in over 1000 cases, has provided an opportunity to study many clinical aspects of renal vascular disease and the role of verious treabnent methods.
258A
George P. Szollar'',