Sir Henry Thompson BT, the first English urologist.

Sir Henry Thompson was a gifted Victorian. As a surgeon he achieved early recognition by successfully removing King Leopold of Belgium's bladder stone where two other eminent surgeons had failed. He was undoubtedly the most famous surgeon of his age, a position he was to occupy for some 30 years. As well as professional eminence he achieved success in an extraordinarily wide range of endeavours. He was an accomplished artist, exhibiting 12 times at the Royal Academy, a connoisseur and collector of china, a keen astronomer, an authority on diet and cooking and a pioneer advocate of cremation. He was interested in poultry-farming, market-gardening and photography. He published two novels sandwiched between a book on tumours of the bladder and another on the prevention of calculous disease, He was a celebrated host and his dinners--called 'Octaves'--at which he served eight courses to eight guests were legendary. To be invited meant one had 'arrived'. He was friendly with artists, scientists and men of letters--Huxley, Browning, Ray Lankester and Thackeray. At the age of 80 he bought himself a motor-car and 2 years later wrote a book on the anatomy of the motor-car engine. Sir Zachary Cope described him as a versatile Victorian, a fitting description of an extra-ordinarily gifted man. A commanding and slightly intimidating figure with little sense of humour, he achieved distinction in professional, artistic and social circles. Not only did he leave his mark on urology he left his mark on Victorian England.

Samuel Pepys and his bladder stone.

Samuel Pepys, as a young man, developed a bladder stone and, by the age of 25 years, realised that only surgery could deliver him from his agony. The chances of success in an age that was ignorant of sepsis were slender, but he opted for surgery. The operation, carried out through the perineum without anaesthetic by a master barber surgeon, was successful and Pepys survived. Although left sterile, he was far from impotent and he went on to achieve fame and fortune as Secretary to the Navy and President of the Royal Society. His greatest fame came after his death with the publication of his diary, which was to become one of the best known and best loved books in the language.

Living-related renal transplantation: Wellington experience.

Living-related renal transplantation as treatment for end-stage renal failure has not been used widely in Australasia. The results of such treatment in 31 patients at Wellington Hospital are described. The five year graft survival of 80.2% encourages us to continue with an active policy of living related transplantation.

A low-power magnification technique for the re-anastomosis of the vas--further results in a personal series of 125 patients.

In 125 patients undergoing reversal of an earlier bilateral vasectomy, a simple technique of re-anastomosis of each divided vas, using low-power magnification (X 3.5) was used. In 51% of couples a normal pregnancy followed and 86% of the males had a sperm count greater than 20 million ml-1. These results compare quite favourably with those obtained using more sophisticated microsurgical techniques.

PIP: In 125 25-56 year old patients undergoing reversal of an earlier bilateral vasectomy, a simple technique of reanastomosis of each divided vas, using low power magnification, was employed. The most common reason for requesting the procedure was a break up of marriage (72%); within this group 51% had remarried or were about to remarry nulliparous women of unknown fertility. The main points of the technique are a limited mobilization of each end of the divided vas to minimize disturbance of the blood supply, an end to end anastomosis of the vas using 4-6 7/0 or 8/0 nonabsorabable sutures inserted under low power magnification (x 3.5), and incorporating the seromuscular layers only. Accurate appositions of each end of the vas with meticulously placed sutures is important to ensure a sperm proof junction. In addition a split of 3/0 nylon 8-10 inches long is left within the lumen of each vas for 8-10 days. Patients were kept on 48-hour bed rest to prevent movement of the vas. Coitus was encouraged after 10-14 days to achieve a pregnancy as soon as possible. 107 patients (86%) had sperm counts in excess of 20 million ml. The successful number of pregnancies was 63 (51%). This experience confirms that a simple technique carried out meticulously under low power magnification can match the results of microsurgical techniques which claim successful pregnancy rates of 50-65%.

A low power magnification technique for reanastomosis of the vas.

PIP: In recent years considerable success has been achieved in the reanastomosis of the divided vas using microsurgical techniques. This report demonstrates that equally good results can be realized using a meticulous but simple technique under low power magnification. Such a technique is within the capability of any competent surgeon. 50 patients, aged between 26-56 years and in whom a bilateral vasectomy for contraceptive purposes had been performed from 14 months-7 years previously, have undergone vasovasostomy. The technique of end-to-end anastomosis of the divided vasa over a nylon splint, using fine interrupted silk sutures, was used in the majority of patients. In the end-to-end technique, each vas is approached through a small vertical scrotal incision, usually at the site of the previous vasectomy. The point of section of the vas is readily identified. It may be represented by a short slender segment of fibrosis or, on occasion, the vas is rejoined and the junction consists of vas of normal caliber with an obliterated lumen. On occasion 1 or other of the divided ends is expanded like drumsticks and they may be joined together or, less often, widely separated. In all cases the divided ends should be identified and cut back until a normal lumen can be identified by passing a blunt-ended number 22 hypodermic needle down both the proximal and distal ends. Each end should be mobilized to allow apposition without tension. A blunt-ended number 22 hypodermic needle is passed down the proximal vas and brought out through the wall of the vas about 2-3 cm from its end. Alternatively, a blunt, atraumatic needle with nylon thread may be passed down the vas and brought out through its wall in the same way. A 30 cm length of 3/0 nylon is threaded through the cannula and the cannula withdrawn over the nylon suture, thus leaving the nylon emerging from the lumen at the proximal end. This end of nylon is threaded up the distal vas for some 20-25 cm. The free end of the nylon emerging from the proximal vas is led out through the adjacent scrotal skin and anchored with an Emesay button. The nylon splints are removed 6-8 days postoperatively. In 42 of the 50 patients operated on motile sperms have reappeared in the ejaculate within 1-3 months following the procedure. In 26 patients (52%) their wives had a normal pregnancy with the birth of a health child. 1 wife aborted spontaneously. This clinical experience suggests that comparable results can be obtained using a conventional technique with low powered magnification, meticulous placement of four 7/0 silk sutures in the muscle layer only over a fine nylon splint removed within 6-8 days.^ieng

The valve of prednisone in the prevention of scarring after vasovasostomy.

A trial, comparing 20 patients undergoing reanastomosis of their vasa following bilateral vasectomy, with 20 patients undergoing the same procedure but in whom prednisone, 40 mg daily for six weeks, had been given to prevent postoperative fibrosis at the anastomotic site, has been conducted. The results suggest that there is a slight increase in the number of successful pregnancies (45% to 55%), and a significant increase in the number of patients in whom sperms have reappeared within the semen (70% to 95%) in the group in whom prednisone has been used.

How effective is a reversal procedure following a vasectomy?

Twenty patients who have requested a reversal procedure following a bilateral vasectomy for sterilisation have been operated upon using a simple end-to-end anastomotic technique on each vas. In nine couples a successful pregnancy has followed, and in 14 of the 20 patients sperms have reappeared in the semen in normal numbers.

The use of a ureteric nipple alone for reflux prevention.

In the re-implantation of a ureter into the bladder, vesico-ureteric reflux can be prevented by a ureteric nipple alone, provided the nipple is at least 1.5 cm long. This eliminates the need for an oblique ureteric entry or a submucosal tunnel. Longer nipples may be used although they may lead to difficulties with catheterisation. Reduction in the length of the nipple frequently occurs later.

Pull-through uretero-lithotomy.

A method for removing a stone from the lower end of the ureter by a pull-through uretero-lithotomy is described.

Letter: Ethics and vasectomy.

PIP: For ethical and legal reasons and as a professional obligation any responsible surgeon performs a vasectomy only after he is completely certain that it is the free wish of both husband and wife.^ieng

Immediate sterility after vasectomy.

A series of 32 males who discontinued all forms of contraception following bilateral vasectomy and irrigation of each vas with 2.5 ml of 1/1000 solution of euflavine, have been followed for one year. During this period in which coitus continued with the same frequency as before vasectomy, no pregnancy has resulted. Semen specimens examined shortly after vasectomy in all subjects showed "moderate" to "many" sperms present in one third of males, and "few" in the remaining two thirds: In all the sperms were non motile.

Immediate sterility after vasectomy.

A 2.5-ml injection of 1/1,000 solution of euflavine given down each vas during vasectomy for sterilization will destroy all sperms within the semen and eliminate the necessity for examining two consecutive specimens of semen for azoospermia after the operation. No local inflammatory response has been observed in the seminal vesicles or prostate of 81 consecutive patients in whom the method has been used.