Postoperative complication from hemostatic clips.

Hemostatic clips were found in a patient's bladder four months after radical retropubic prostatectomy. A calculus, which had formed on one clip, caused acute urinary retention. Inadvertent enclosure of the hemoclips within the bladder intraoperatively and early intraurethral migration of the hemoclips are possible causes of this complication. Although this problem is rarely reported, hemoclips should be used sparingly, if at all, around the vesicourethral anastomosis.

The new ALR long cystoresectoscope system.

A new long cystoresectoscope system recently has become available. This instrument has the distinct advantage of allowing cystoscopy and endoscopic surgery of the lower urinary tract in men with an unusually long urethra, or a semirigid or intracorporeal inflatable prosthesis.

Finney flexirod prosthesis.

The experience gained from the implantation of 763 Flexirod Prosthesis is described. Special features of this design include a tapered distal tip which provides for better glans stability, a soft hinge which allows for improved penile concealment, and a trimmable tail which, together with preoperative measurement of the penis, allows the surgeon to determine the correct prothesis size well in advance of surgery. The surgical procedure is not difficult, the complication rate is low, device failure is extremely rare, and most patients are restored to a satisfactory sex life.

Urinary tract infection after transrectal needle biopsy of the prostate.

After routine cleansing enemas 80 patients were randomized to undergo irrigation of the rectal vault with either povidone-iodine or saline. A transrectal prostatic needle biopsy then was performed. Antimicrobials were not used before biopsy and were only ordered after biopsy if fever developed or a positive urine culture was obtained. Over-all, 41 per cent of the patients had positive urine cultures post-biopsy and 44 per cent had febrile episodes. There was no significant difference between the group receiving the povidone-iodine versus those receiving saline irrigations.

Surgical management of "pus-pot" perineum.

Ten cases of disabling "pus-pot" perineum secondary to hidradenitis suppurativa, urethral stricture disease, condyloma acuminatum and anoperineal fistula were treated by wide excision of involved tissues. In 7 men the testicles were transposed to thigh pouches, and in 3 the entire penile skin was excised and replaced with a skin graft.

Lack of value of routine preoperative bone and liver scans in cystectomy candidates.

A retrospective review of 341 patients with bladder cancer revealed 58 candidates for cystectomy. These patients were evaluated preoperatively by radionuclide bone and/or liver scans in an attempt to increase the accuracy of clinical staging. In the face of a normal history, physical examination, liver function tests or serum alkaline phosphatase routine preoperative bone and liver scans in cystectomy candidates did not contribute significantly to clinical staging or choice of treatment. Since liver and bone scans add significantly to the cost of the illness their use should not be routine but reserved only for those special cases when they are indicated.

Evaluation of povidone-iodine as vesical irrigant for treatment and prevention of urinary tract infections.

This is a preliminary study evaluating diluted solutions of povidone-iodine (PVP-I) as urinary bladder irrigants for the treatment and prevention of urinary tract infection. Diluted povidone-iodine solutions were used as indwelling catheter irrigants and as instillations into the urinary bladder following intermittent catheterization. The diluted PVP-I solutions had no efficacy in either the treatment or prevention of urinary tract infections when used as indwelling urethral or suprapubic catheter irrigants. There was a suggestion of a slight decrease in the incidence of urinary tract infections during the use of PVP-I in the intermittent catheterization group in this uncontrolled study, but the percentage of positive urine cultures was greater than desired. The absence of any unfavorable data has led us to conclude that the diluted PVP-I caused no undesirable side effects in any of the patients treated with this agent, PVP-I bladder irrigation warrants further investigation in special cases such as lower urinary tract fungal infections.

Finney hinged penile implant: experience with 100 cases.

The flexirod hinged penile prosthesis was implanted in 100 patients: 21 through a perineal incision and 79 through a dorsal penile incision. Surgery via the dorsal approach is performed more easily and quickly, and produces less postoperative pain. The modified technique and results for the hinged implant are described. The complication rate was 5 per cent (4 per cent once the design of the prosthesis was finalized).

Glomerulonephritis and virus-like particles associated with prostatic cancer.

A patient with carcinoma of the prostate and metastases developed the nephrotic syndrome following hormonal therapy. A decrease in the dose of estrogens was associated with decreased proteinuria, but when therapy was increased the nephrotic syndrome became more severe. Renal biopsy performed when proteinuria was present showed subendothelial electron dense deposits, complement by immunofluorescence, and a morphologic pattern of membranoproliferative glomerulonephritis. There was evidence of resorption of the deposits by endothelial cells. Microspherical particles resembling those described in prostatic cancer were found in the glomeruli. On the basis of previous reports it is concluded that circulating tumor antigen-antibody complexes produced glomerulonephritis, the severity of which was related to the amount of soluble antigen released by tumor cell destruction. Apparent phagocytosis of immune complexes by glomerular endothelial cells was believed to account for the reversibility of the nephrotic syndrome. The role of the virus-like particles in the process is as yet unclear.

New technique for percutaneous nephrostomy under ultrasound guidance.

The 8F cystocath has been used as a temporary percutaneous nephrostomy. B-mode ultrasonography was used to determine the depth and direction of trocar placement after initial confirmation with a spinal needle. No immediate complications were noted in 10 successful insertions and there was only 1 failure of entry.

Experience with new double J ureteral catheter stent.

Experience with a newly designed self-retaining silicone ureteral stent is presented. The stent is supplied in various lengths, has a J or hook molded into each end to prevent migration and has been designed specifically to be passed during an open operation as well as endoscopically. The device is used to provide free drainage to the bladder, reduce or eliminate urine leakage, provide stenting of the ureter and allow for earlier discharge from the hospital of patients without external catheters. In some cases the stent may be used instead of a nephrostomy tube to provide prolonged drainage with less chance of infection. It is removed easily in the outpatient facility by cystoscopy.

New hinged silicone penile implant.

A new paired hinged silicone prosthesis is described. The hinge allows the penis to move freely and hang in a dependent position without constrictive clothing and permits satisfactory coitus. A conical tip more nearly conforms to the distal corpus and the proximal end may be trimmed during the operation to fit the individual patient.