Recent experiences with transurethral urological surgery

From observations, one may conclude that: 1. Transurethral prostatic resection has a definite place in prostatic surgery, but it should be tried only by those with the necessary training in cystoscopic vision with the foroblique lens. (I have purposely not mentioned the cold punch technique of resection, which is more difficult to master and requires as a background cystoscopic experience with the direct vision cystoscope)2. The resectoscope extends further our therapeutic armamentarium against bladder newgrowths: for, with the movable loop of the instrument, one can extirpate tumors from the bladder as easily and as efficiently as through the open bladder3. Cystoscopic fulguration of bladder tumors and crushing of bladder stones may also be accomplished through urologic surgery that makes use of the natural route. (Summary)

Paragonimiasis westermani: an unexpected case with cystic formation in the anterior abdominal wall

1. A case of Paragonimiasis westermani diagnosed for the first time in life in the Philippines through a histopathological examination of an excised cyst from the anterior abdominal wall discharging pus through the umbilicus, is here presented as a unique contribution to the very meager literature on the subject. The parasitic nature of the cyst was never thought of even by the surgeons until after eggs were found in the tissue section, which were identified as Paragonimus ova by the senior author. This discovery through biopsy may be considered unusual at present; but it is hoped, that after this report, such findings would no longer be strange, especially considering that eggs of Paragonimus are found not only in the lungs but also in many other organs and tissues of the body. The attention of the general and cancer pathologists is called to this important possibility in biopsy2. A further study of the patient, as suggested by the histopathological finding, has revealed that it is not difficult to establish the presence of pulmonary paragonimiasis, since the ova are easily demonstrable both in the sputum and the feces. This procedure of demonstrating and recognizing the Paragonimus ova, especially in the grayish or brownish sputum of patient, can easily be done by a competent parasitologist3. The X-ray examination of this patient further revealed an important finding of cyst-like shadows on both sides of the lungs, more especially on the right, which, to the radiologist, is very suggestive of pulmonary paragonimiasis. The attention of the radiologist, especially those engaged in tuberculosis work, is called to this important X-ray finding; and, whenever such suspicious cases are encountered, the sputum of the patient whould always be examined, not only for T.B. bacilli, but also for Paragonimus ova. The stress should naturally be more in the intelligent and active search, in order to discover hidden, unseen, or hitherto unrecognized casesWith these few hints and the sustained interest of the entire medical profession all over the Islands in Paragonimiasis manifested either individually or with others who may have the facilities, we hope that, before long, we can become Paragonimus-conscious4. With the interest or Paragonimus-mindedness that might be brought about by the suggestions given in this paper, it is hoped that, in the near future, every-one will be able to contribute towards enriching our knowledge of Paragonimiasis, which is still very meager, because of our own neglect and indifference. (Summary and Conclusions)

Statistical studies on urolithiasis: II. clinical aspects

A series of 134 operative cases of urolithiasis is presented. There were 22 kidney stones, 18 ureteral, 87 bladder, and 7 urethral. There have been 12 deaths in these showed a preponderance of phosphates in 28 samples or 70%. All of these stones were associated with urinary infection. (Summary)

Surgical problems in urinary lithiasis

A rapid survey of the 253 cases of urinary lithiasis shows 57 cases with obstruction below the stone. This gives an incidence of 22.3. Since practically all of these 253 cases had infected urine, the absence of close relation between the incidence of urinary infection and urinary obstruction would seem to preclude any possibility of cause-and-effect relations between the two factors. However, the high incidence of urinary infection in the cases of lithiasis discussed above cannot be of etiologic significance, as far as infection is concerned, unless it be proven in every instance of lithiasis that there had been an antecedent urinary infectionNothing of the sort was found in my cases. One is tempted to conclude, therefore, that neither infection nor obstruction had much significance in the production of stones in these patients, although, once the stone had formed, infection and obstruction might possibly accelerate the growth of the stone, even to the extent of perpetuating the lithiasic stateSuch a superficial analysis as this of a small series cannot very well advance, except by elimination, the studies on the etiology of stone. It can only be hoped that, when a thousand of more cases are studied and more histological sections of the urinary tract are made, some more light may be shed on the problem. For when one says that the majority of the stones in this series are "primary" stones, the use of the adjective "primary" wound only reveal an ignorance of elusive etiologic factors.(Summary and Comments)

Renal arteriography

In selected and well-screened hypertensives, renal arteriography is an indispensable diagnostic tool for establishing a possible renovascular cause for the high blood pressure. Positive angiographic findings may be expected in 40% of renovascular suspects submitted to this procedure. At the present time we are getting more conclusive renal angiograms by the retrograde transfemoral route and have used this approach in fifteen instances. There has not been any noteworthy complication arising from transfemoral approach in those cases we have personally done. In most instances a positive renal angiogram not only concluded the study of the patient but it also provides the surgeon and the urologist with a pre-operative plan in dealing with the pathology in each individual case.(Summary)

Surgical considerations in nephrolithiasis

For the successful removal of kidney stones, the kidney and upper ureter should be correctly exposed by the proper lumbar extraperitoneal incision. The size and location of the stone, as well as the perirenal pathology and anatomic variations of the kidney, influence the methods of surgical removal. An incision through the renal pelvis is much to be preferred to that through the cortex for anatomic and functional reasons, but it has been found possible in only about 25 of patients herein reported (exclusive of those nephrectomized). The closure of pyelotomy is easily performed, that of a nephrotomy just as easily but with subsequent diminution of renal function due to constriction of endarteries. Accessory extrarenal obstructive factors must be attended to. Resection of the lower pole to remove a dependent stone-bearing lower calyx is a logical step in the prevention of recurrences. Badly damaged kidneys will have to be completely removed in unilateral cases. (Summary)