Hemostatic control with flexible compression tape used during partial nephrectomy and organ salvage.

PURPOSE: A secure method of achieving hemostasis during partial nephrectomy to accomplish guillotine polar amputation is described. MATERIALS AND METHODS: A common hardware item, the so-called cable tie, proved to be useful during removal of a block of neoplastic renal tissue from the lower central pole of a unilateral kidney. RESULTS: Complete hemostasis and resection of the renal parenchyma were obtained with ease and minimal expense. CONCLUSIONS: The use of a flexible plastic compression tape has proved valuable to adhere to organ contours closely, maximally control bleeding and marking a line of incision during amputation of a portion of the renal substance. This device may prove useful for analogous surgical purposes with other vascular organs.

Multiple rheumatoid nodules of the renal cortex.

We report the findings of a large localized collection of rheumatoid nodules in the renal cortex of a male patient with long-standing seropositive rheumatoid arthritis. Rheumatoid nodules are a rare occurrence in the urinary tract, with only two previous reports of renal involvement, to our knowledge. A possible relationship, on the basis of immunologically mediated mechanisms, to accompanying chronic pyelonephritis is proposed.

New coaxial ureteral stricture knife.

Open surgical repair of upper urinary collecting system strictures or obstructions is difficult and is less likely to be accepted by the patient than an endoscopic or ureteroscopic approach. In the hands of an experienced urologic endoscopist the use of our cold blade has the advantage of less trauma to the ureter, already compromised by poor blood supply, than blind dilation; there is visual control of the procedure and acceptance by the patient that the urologic surgeon is doing the procedure; and it is adaptable to rigid or flexible endoscopes and ureterorenoscopes. Furthermore, there is information that the results are better, at least in the short term, than the more traumatic endoscopic procedures associated with dilation. However, only long-term future series will give us an evolving view of this resistant problem. Finally, the ureteral knife we have developed has the potential to be converted to an electrosurgical device for incision or coagulation, when appropriate. An application is pending with the US Food and Drug Administration concerning electrosurgical applications of the ureteral knife (in conjunction with J.R. La Course, PhD, and G.C. Gerhard, PhD, Department of Electrical Engineering and Computer Sciences, University of New Hampshire, Durham). The high dielectric constant of the sheath, combined with hemostatic or incisional properties in this latter mode, would likely prove advantageous.

Perineal urethrostomy to facilitate gaining ureterorenoscopic length.

A simple method of gaining ureterorenoscopic length via a perineal urethrostomy and its use in an obese, 6-foot, 6-inch man with a suspected renal pathological condition is described.

Electric current and voltage recordings on the myocardium during electrosurgical procedures in canines.

Voltage and current spectra were measured with probes placed directly on the canine myocardium during transurethral resection (TUR). It was determined that three factors may be related to potential cardiac effects during electrosurgical procedures: obvious low frequency components modulated from a center frequency of the electrosurgical generator; high current density due to high power setting during TUR, and duration of application of the cutting waveform.

Chronic balanitis owing to pemphigus vegetans.

Pemphigus is an autoimmune bullous dermatosis in which intercellular antibodies are associated with loss of intercellular cohesion. Pemphigus vegetans, a rare variant of pemphigus, is manifested by vegetating plaques, usually in intertriginous areas of patients who probably have an increased resistance to the disease. We report a case of chronic balanitis owing to pemphigus vegetans, and discuss proposed pathogenic mechanisms and treatment.

Primary leiomyosarcoma of the seminal vesicle.

A leiomyosarcoma of the seminal vesicle, found at an early stage on routine rectal examination, is described. The authors believe that this report represents, to date, the most conclusive documentation of primary origin of a sarcoma in the seminal vesicle. It is also the first report in which electron microscopy yielded definitive diagnostic information. Review of the previously reported cases suggests that radical surgery may offer a realistic chance for cure.

A programmable variable waveshape generator for electrosurgical research.

A variable waveform electrosurgical unit (VWESU) was designed and used for electrosurgical research. The design criteria included the ability to modulate the amplitude of a sinusoidal carrier on a cycle-by-cycle basis, output power equivalent to commercial generators, and provision for varying the output impedance. These were realized with a microprocessor-controlled variable waveform generator which allows the user to program waveforms into memory with a set of simple descriptive commands, a linear power amplifier, and a custom output transformer. The contents of the memory are directly pipelined to a set of analog switches, which modulate the radio-frequency carrier with one of eight amplitude levels, thereby bypassing the speed limitations of the microprocessor.

Epididymitis nodosa. An epididymal lesion analogous to vasitis nodosa.

We studied eight cases of an epididymal lesion resembling vasitis nodosa. Four cases were encountered among a group of patients who underwent epididymectomy for pain following vasectomy. The other four cases occurred in the absence of that history. The lesion probably represents a regenerative effort following rupture of a duct resulting from long-standing obstruction, either locally or at some point distally in the ductal system. Recognition is important to prevent misdiagnosis as a neoplasm.

A late post-vasectomy syndrome.

A group of 20 surgical specimens in 18 patients with a previously unappreciated syndrome of unremitting epididymal pain and induration 5 to 7 years after vasectomy was collected during a 2-year interval. These symptoms uniformly were unresponsive to conservative measures, including empiric antibiotics. Total unilateral or bilateral epididymectomy and partial vasectomy led to complete relief of symptoms, usually within 24 hours. Pathological examination of the specimens revealed features consistent with sequelae of long-standing obstruction. Recognition of this late post-vasectomy syndrome, which represents a major complication of vasectomy, might be expected to increase as cohorts of vasectomized individuals age.

Mule spinner's disease.

Mule spinner's disease represents the occurrence of scrotal cancer in cotton textile workers exposed to mineral oils on a long-term basis while working on a machine called "the mule." We describe a 66-year-old cotton textile worker who had frequent scrotal contact with mineral oils and later had multiple squamous cell carcinomas of the scrotum develop. He also had a variety of other keratotic lesions develop on the scrotum that histopathologically demonstrated features of verruca, lichenoid keratoses, and squamous cell carcinomas in situ. We have termed these lesions mule spinner's keratoses.

Prevention of vesicoureteral reflux with Fogarty catheters during formalin therapy.

Vesicoureteral reflux during formalin therapy of intractable hemorrhagic cystitis can be prevented with Fogarty catheters inserted cystoscopically into the lower ureters. With this technique formalin instillation and cystography can be done through the cystoscope at the same time. Topical intravesical vasopressin did not, in our experience, lessen the bladder hemorrhage.

Penetrating high-velocity genitourinary injuries. Part II: Ureteral, lower tract, and genital wounds.

Penetrating ureteral wounds appear to occur at a constant low rate and demand internal splinting without ureterotomy drainage in the multiple-injured patient. Concomitant upper urinary tract and colonic or pancreatic injury absolutely requires the use of nephrostomy drainage. Most prostatic or prostatomembranous rupture can be approached retropubically, or if extensive tissue damage and uncontrollable hemorrhage are present, by transpubic methods. Intravesical fixation of the prostatomembranous rupture provides the best anchorage and approximation. Rectoprostatic-bladder wounds should be approached suprapubically and may be drained transcoccygeally also. Section of the obturator nerve may provide postoperative pain relief in severe pubic ramus fractures. Small high-velocity entrance wounds in the external genitalia warrant exploration because of great internal disruption. The skin of the external genitalia should be closed primarily.

Penetrating high-velocity genitourinary injuries. Part I. Statistics mechanisms, and renal wounds.

As a consequence of missile-tissue energy exchange, high-velocity missile wounds necessitate wide surgical debridement because of severe tissue contusion distant from the wound tract. A missile tract mentally projected by the physician through the urologic tract demands appropriate investigation. The approach to urologic surgery may be primarily determined by the wound tract since this has to be debrided anyway. Ureteral filling on an intravenous pyelogram will save valuable time at surgery. High-velocity penetrating renal injury demands an aggressive surgical approach to obviate later complications.