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The New Alr Long Cystoresectoscope System
0022-534 7/85/1343-0509$02.00/0
Vol. 134, September Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1985 by The Williams & Wilkins Co.
THE NEW ALR LONG CYSTORESECTOSCOPE SYSTEM ROY P. FINNEY From the Division of Urology, University of South Florida and the James A. Haley Veterans Administration Hospital, Tampa, Florida
ABSTRACT
A new long cystoresectoscope system recently has ~ecome available. This i~strument ~as the distinct advantage of allowing cystoscopy and endoscopic surgery of the lower urmary tract m men with an unusually long urethra, or a semirigid or intracorporeal inflatable prosthesis. The development of penile prostheses has produced a revolution in the treatment of organic impotence but this has not been achieved without undesirable side effects. Cystoscopy and endoscopic surgery of the lower urinary tract have bee~ made much more difficult or impossible with standard length mstruments. The implantation of semirigid penile prostheses, such as the Small-Carrion, Finney Flexirod, Jonas or the new intracorporeal inflatable prostheses, lengthens the penis and the urethra to such an extent that in most patients only a portion of the prostate may be visualized. Additional pressure on the cystoscope may rupture the relatively thin tissues between th~ shea~h and the distal prosthesis in the region of the fossa nav1culans, requiring removal of 1 or both implants. While it is possible to perform cystoscopy and transurethral prostatic resection through a perineal urethrostomy, this procedure is not wit~10ut possible complications, including infection of the prosthesis. Because of the inability to visualize the bladder adequately and especially to perform transurethral bladder resection, most patients with bladder tumors have had the prosthesis removed and either had recurrent impotence or changed to the more complex prostheses with reservoirs located within the pelvis (Scott or Mentor device).
RESULTS
Cystoscopy has been performed on 27 patients primarily to evaluate the prostate, since the lateral lens is not yet available. The bladder can be examined except in the area adjacent to the bladder neck. Transurethral resection of the prostate was done without difficulty in 11 patients. Superficial transitional cell carcinoma of the bladder was diagnosed in 3 patients with a combination of standard length cystoscopic instruments and the ALR system, and the tumors were resected completely with the longer instrument. Two paraplegic men with Flexirod II prostheses underwent sphincterotomy with excellent results. DISCUSSION
A word of caution should be given. By years of habit, urologists are used to inserting standard length cystoscopic instruments into the bladder for the full length of the instrument. Because of this habit it is not infrequent for contracted bladders to be perforated with standard instruments. The endoscopist must remember that this instrument is significantly longer and care must be taken when advancing the sheath. This new longer instrument has proved to be a useful addition to the urological armamentarium.
MATERIALS AND METHODS
Problems associated with cystoscopy and endoscopic surgery in patients with these intracorporeal prostheses have been eliminated largely by the introduction of an entirely new cystoresectoscope (the ALR Long Resectoscope System*), which is approximately 11 cm. longer than standard instrumen~s (see figure). To date, this system includes a long 30-degree obliquely forward lens, 24F and 28F resectoscope sheaths with obturators, and longer stabilized cutting loops. The standard length resectoscope working element functions well with this system. A lateral view telescope and smaller diameter cystoscope sheath& should become available relatively soon. Accepted for publication May 8, 1985. * American Cystoscope Makers, Inc., Stamford, Connecticut 06904.
509
A
New ALR long cystoresectoscope (A) is compared to standard instrument (B). Additional 11 cm. length permits examination and endoscopic surgery in men with penile prosthesis or unusually large penis.
Vol. 134, September Printed in U.S.A.
THE JOURNAL OF UROLOGY
Copyright © 1985 by The Williams & Wilkins Co.
THE NEW ALR LONG CYSTORESECTOSCOPE SYSTEM ROY P. FINNEY From the Division of Urology, University of South Florida and the James A. Haley Veterans Administration Hospital, Tampa, Florida
ABSTRACT
A new long cystoresectoscope system recently has ~ecome available. This i~strument ~as the distinct advantage of allowing cystoscopy and endoscopic surgery of the lower urmary tract m men with an unusually long urethra, or a semirigid or intracorporeal inflatable prosthesis. The development of penile prostheses has produced a revolution in the treatment of organic impotence but this has not been achieved without undesirable side effects. Cystoscopy and endoscopic surgery of the lower urinary tract have bee~ made much more difficult or impossible with standard length mstruments. The implantation of semirigid penile prostheses, such as the Small-Carrion, Finney Flexirod, Jonas or the new intracorporeal inflatable prostheses, lengthens the penis and the urethra to such an extent that in most patients only a portion of the prostate may be visualized. Additional pressure on the cystoscope may rupture the relatively thin tissues between th~ shea~h and the distal prosthesis in the region of the fossa nav1culans, requiring removal of 1 or both implants. While it is possible to perform cystoscopy and transurethral prostatic resection through a perineal urethrostomy, this procedure is not wit~10ut possible complications, including infection of the prosthesis. Because of the inability to visualize the bladder adequately and especially to perform transurethral bladder resection, most patients with bladder tumors have had the prosthesis removed and either had recurrent impotence or changed to the more complex prostheses with reservoirs located within the pelvis (Scott or Mentor device).
RESULTS
Cystoscopy has been performed on 27 patients primarily to evaluate the prostate, since the lateral lens is not yet available. The bladder can be examined except in the area adjacent to the bladder neck. Transurethral resection of the prostate was done without difficulty in 11 patients. Superficial transitional cell carcinoma of the bladder was diagnosed in 3 patients with a combination of standard length cystoscopic instruments and the ALR system, and the tumors were resected completely with the longer instrument. Two paraplegic men with Flexirod II prostheses underwent sphincterotomy with excellent results. DISCUSSION
A word of caution should be given. By years of habit, urologists are used to inserting standard length cystoscopic instruments into the bladder for the full length of the instrument. Because of this habit it is not infrequent for contracted bladders to be perforated with standard instruments. The endoscopist must remember that this instrument is significantly longer and care must be taken when advancing the sheath. This new longer instrument has proved to be a useful addition to the urological armamentarium.
MATERIALS AND METHODS
Problems associated with cystoscopy and endoscopic surgery in patients with these intracorporeal prostheses have been eliminated largely by the introduction of an entirely new cystoresectoscope (the ALR Long Resectoscope System*), which is approximately 11 cm. longer than standard instrumen~s (see figure). To date, this system includes a long 30-degree obliquely forward lens, 24F and 28F resectoscope sheaths with obturators, and longer stabilized cutting loops. The standard length resectoscope working element functions well with this system. A lateral view telescope and smaller diameter cystoscope sheath& should become available relatively soon. Accepted for publication May 8, 1985. * American Cystoscope Makers, Inc., Stamford, Connecticut 06904.
509
A
New ALR long cystoresectoscope (A) is compared to standard instrument (B). Additional 11 cm. length permits examination and endoscopic surgery in men with penile prosthesis or unusually large penis.