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)

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)

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)