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Vesical Bladder Stones Formed Around Non-Absorbable Sutures and Possible Explanation for Their Delayed Appearance
0022-534 7/79/1226-0849$02.00/0 THE ,JOURNAL OF UROLOGY
Vol. 122, December Printed in U.S.A.
Copyright© 1979 by The Williams & Wilkins Co.
Letters to the Editor VESICAL BLADDER STONES FORMED AROUND NONABSORBABLE SUTURES AND POSSIBLE EXPLANATION FOR THEIR DELAYED APPEARANCE
To the Editor. Hanging bladder stones attached to a non-absorbable suture probably are a common occurrence. Therefore, it seems curious that such a case was first in 1955. 1 In all cases reported the sutures penetrating the had been placed during a previous pelvic operation. In 2 recent cases symptoms of recurrent cystitis appeared 4 and 5 after gynecologic In both cases the stones a diameter of f'L'J&au,wa,_y 6 to 7 n1m. In 1 case the suture vvas attached to the bladder mucosa; the calculus was detached easily the suture by a gedle pull (see figure). In the
1. Levack, J. H.: Hanging bladder stones formed on unabsorbable
suture and ligature. Brit. J. Urol., 27: 239, 1955. 2. Von Schneider, H. J., Albert, L. and Hesse, A.: Der Einfluss des N ahtmateriais auf die experimentelle Blasensteinbildung. Z.
Exper. Chi.r., 5: 346, 1972. 3. del Vaglio, B. and 1v;s,rn,aua1u R.: Migrazione in vesica di fili di seta sottoposta a tagli cesarei. Arch. con formatione di calcolo in Ital. Ure!., 39: 157, 1967.
RE: SYSTEMIC ANTIBIOTICS FOR PROPHYLAXIS IN UROLOGIC SURGERY: A CRITICAL REVIKW
G. W. Chodak and M. E. Plaut J. Urol., 121: 695-699, 1979
other case the suture had to be severed endoscopically and pulled out. The sutures in both cases probably were placed extra-luminallyotherwise the bladder stones probably would have formed much more rapidly. 2 Non-absorbable sutures may migrate through tissues.' This would explain how the sutures in these 2 cases would reach the lumen of the bladder and why the calculi developed only after a delay of several years. It is important to keep in mind the possibility of migration of nonabsorbable sutures toward the lumen of a hollow organ whenever applied in the proximity of such an organ.
M. B. Goldstein and N. L. Vartanian '""11.uwrn California . w.1.rnr.n w 90033
Medical Center
To the Editor. Chodak and Plaut are to be congratulated on their effort to clarify the still obscure subject of antibiotic ,wc,uu vw,u"' m urologic surgery. We conducted 2 nr,~~rwr·tnJP trials using cephalosporins and in patients who had sterile urine before undergoing transurethral prostatectomy. 1' 2 We concluded that transurethral resection of uninfected patients can be performed safely without antibiotics but that cephalosporins and nitrofurantoin significantly reduce the incidence of bacteriuria immediately and 1 month postoperatively. Our results also suggest that the organisms found in the urine after transurethral resection ascend along the catheter and do not come from the prostate, since nitrofurantoin (which does not reach significant concentrations in tissue) was as effective as cephalosporins in preventing postoperative bacteriuria. Although more studies, performed in the manner suggested by Chodak and Plaut, may be useful we can state that transurethral resection of the prostate can be done safely without antibiotics in with sterile mine preoperatively. The surgeon choose of 2 courses of action to deal with postoperative na,.,,-,,,,,,r, 1) the use of prophylactic oral antibacterial medications starting before the operation and continuing until after removal of the catheter or 2) obtaining urine cultures the day after removal of the catheter and treating only those patients with infected urine. With the present methods of trans urethral resection and postoperative catheter care we are convinced that the 2 courses of action are equally safe. Respectfully,
Ricardo Gonzalez Department of Urologic Surgery University of Minnesota College of Health Sciences Minneapolis, Minnesota 55455
l. Gonzalez, R., Wright, R. and Blackard, C. E. : Prophylactic antibiotics and transurethral prostatectomy. J. Urol., 116: 203, 1976.
2. Matthew, A. D., Gonzalez, R., Jeffords, D. and Pinto, M. H.: Prevention of bacteriuria after transurethral prostatectomy with nitrofurantoin macrocrystals. J. Urol., 120: 442, 1978 .
Vol. 122, December Printed in U.S.A.
Copyright© 1979 by The Williams & Wilkins Co.
Letters to the Editor VESICAL BLADDER STONES FORMED AROUND NONABSORBABLE SUTURES AND POSSIBLE EXPLANATION FOR THEIR DELAYED APPEARANCE
To the Editor. Hanging bladder stones attached to a non-absorbable suture probably are a common occurrence. Therefore, it seems curious that such a case was first in 1955. 1 In all cases reported the sutures penetrating the had been placed during a previous pelvic operation. In 2 recent cases symptoms of recurrent cystitis appeared 4 and 5 after gynecologic In both cases the stones a diameter of f'L'J&au,wa,_y 6 to 7 n1m. In 1 case the suture vvas attached to the bladder mucosa; the calculus was detached easily the suture by a gedle pull (see figure). In the
1. Levack, J. H.: Hanging bladder stones formed on unabsorbable
suture and ligature. Brit. J. Urol., 27: 239, 1955. 2. Von Schneider, H. J., Albert, L. and Hesse, A.: Der Einfluss des N ahtmateriais auf die experimentelle Blasensteinbildung. Z.
Exper. Chi.r., 5: 346, 1972. 3. del Vaglio, B. and 1v;s,rn,aua1u R.: Migrazione in vesica di fili di seta sottoposta a tagli cesarei. Arch. con formatione di calcolo in Ital. Ure!., 39: 157, 1967.
RE: SYSTEMIC ANTIBIOTICS FOR PROPHYLAXIS IN UROLOGIC SURGERY: A CRITICAL REVIKW
G. W. Chodak and M. E. Plaut J. Urol., 121: 695-699, 1979
other case the suture had to be severed endoscopically and pulled out. The sutures in both cases probably were placed extra-luminallyotherwise the bladder stones probably would have formed much more rapidly. 2 Non-absorbable sutures may migrate through tissues.' This would explain how the sutures in these 2 cases would reach the lumen of the bladder and why the calculi developed only after a delay of several years. It is important to keep in mind the possibility of migration of nonabsorbable sutures toward the lumen of a hollow organ whenever applied in the proximity of such an organ.
M. B. Goldstein and N. L. Vartanian '""11.uwrn California . w.1.rnr.n w 90033
Medical Center
To the Editor. Chodak and Plaut are to be congratulated on their effort to clarify the still obscure subject of antibiotic ,wc,uu vw,u"' m urologic surgery. We conducted 2 nr,~~rwr·tnJP trials using cephalosporins and in patients who had sterile urine before undergoing transurethral prostatectomy. 1' 2 We concluded that transurethral resection of uninfected patients can be performed safely without antibiotics but that cephalosporins and nitrofurantoin significantly reduce the incidence of bacteriuria immediately and 1 month postoperatively. Our results also suggest that the organisms found in the urine after transurethral resection ascend along the catheter and do not come from the prostate, since nitrofurantoin (which does not reach significant concentrations in tissue) was as effective as cephalosporins in preventing postoperative bacteriuria. Although more studies, performed in the manner suggested by Chodak and Plaut, may be useful we can state that transurethral resection of the prostate can be done safely without antibiotics in with sterile mine preoperatively. The surgeon choose of 2 courses of action to deal with postoperative na,.,,-,,,,,,r, 1) the use of prophylactic oral antibacterial medications starting before the operation and continuing until after removal of the catheter or 2) obtaining urine cultures the day after removal of the catheter and treating only those patients with infected urine. With the present methods of trans urethral resection and postoperative catheter care we are convinced that the 2 courses of action are equally safe. Respectfully,
Ricardo Gonzalez Department of Urologic Surgery University of Minnesota College of Health Sciences Minneapolis, Minnesota 55455
l. Gonzalez, R., Wright, R. and Blackard, C. E. : Prophylactic antibiotics and transurethral prostatectomy. J. Urol., 116: 203, 1976.
2. Matthew, A. D., Gonzalez, R., Jeffords, D. and Pinto, M. H.: Prevention of bacteriuria after transurethral prostatectomy with nitrofurantoin macrocrystals. J. Urol., 120: 442, 1978 .