Intussusception technique for use in duplicated system.

Removing a ureter by intussuscepting it into the bladder has been described previously; but so far use of this technique was thought to be contraindicated in the presence of a duplicated system. We have modified this technique so that intussusception can now be used in a duplicated system as well. Two cases are presented.

Transperineal percutaneous I-125 implant of prostate.

Although Iodine-125 seeds for interstitial radiation of prostatic cancer via the retropubic route is an established method of treatment, the retropubic implant technique has disadvantages: inadequate space for proper placement of the needles, possible bleeding from the prostatic venous plexus by the insertion of needles through these veins, and possible wound infection due to inadvertent puncturing of the bladder and/or rectum by the needles. A technique is described whereby Iodine-125 seeds for interstitial radiation are placed into the prostate through the perineum allowing more accurate placement of the seeds, assuring homogenous dose distribution, and decreasing the risk of bleeding and of bacterial contamination.

Polyglactin 910 suture in urinary tract.

Cystotomies in guinea pigs and ureteral anastomoses in dogs were sutured with polyglactin 910. Silk and chromic catgut were used as control sutures in the bladders and chromic catgut in the ureters. Three months postoperatively in bladders sutured with polyglactin 910 small epithelial cysts were noted, which increased in size with time. In ureters sutured with polyglactin 910 cystic diverticula were observed eight months postoperatively. Because of the difference of tissue reaction to polyglactin 910 compared with catgut, further long-term studies are urged in different species of animals, prior to the clinical use of polyglactin 910 in the urinary tract.

Bilateral fibroepithelial polyps of ureter in a child.

Presented here is the first case of bilateral ureteral polyps in a patient under eighteen years of age, with vivid colored intraoperative photographs. The importance of careful identification of the base of the polyp to reduce operative morbidity and the necessity of ureteral reanastomosis rather than simple excision of the polyp in children is emphasized.

Ureteral reaction to suture material.

Dog ureters were anastomosed end to end using either chromic catgut, polyglycolic acid (PGA), polyglactin-910, or polypropylene sutures. Analysis of luminal diameters, fibrosis, scar vascularity, and inflammatory reaction four and seven months later indicated that in ureters of the uninfected dog the best results were obtained with polyglycolic acid. Ureters anastomosed with catgut gave results that were slightly less acceptable.

Diagnosis and treatment of fluid-filled renal structures in children with ultrasonography and percutaneous puncture.

The application of ultrasonographic and percutaneous needle puncture techniques in the diagnosis of various fluid-filled renal anomalies has permitted rapid delineation of anatomic detail, more definitive physiologic evaluation, and drainage, when necessary, in a safe and cost-effective manner. Its usefulness in children is emphasized in 6 illustrated cases of male infants with minimally or nonopacified renal anomalies, one of the more difficult diagnostic problems in pediatric urology.

Transperineal 125iodine endocurietherapy of prostate cancer.

We present the improved implant technique, intraoperative and postoperative complications, local control, and survival of 67 patients with cancer of the prostate treated by means of percutaneous transperineal template permanent 125iodine interstitial endocurietherapy (ECT). This ECT technique is a simple, easily learned, accurate and rapid procedure that can be performed without subjecting the patient to celiotomy. The use of vicryl carriers for permanent 125iodine implantation of the prostate with the percutaneous transperineal template technique prevents seed loss and permits implantation of patients after transurethral resection of the prostate (TURP).

I-125 implant of the prostate: a new technique.

Retropubic I-125 implantation of the prostate at the time of suprapubic extraperitoneal pelvic lymphadenectomy is a well-established method of treatment for stages B(2) and early C prostatic cancer. However, there are some technical disadvantages with the retropubic I-125 implant technique, such as inadequate space for proper placement of the needles; bleeding, uncontrollable at times, from the periprostatic venous plexus secondary to insertion of needles into the prostate; and superficial wound infection due to inadvertent puncturing of the bladder and/or rectum by the needles. In this paper the authors describe a new technique which eliminates the technical problems associated with retropubic I-125 implantation of the prostate.

Iodine 125 interstitial irradiation for localized prostate cancer.

We present the technique, complications, and 5-year results of transperineal percutaneous template permanent interstitial iodine 125 endocurietherapy of localized prostate cancer in 85 treated patients. The 5-year outcome appears similar to that of external beam radiation therapy or radical surgery, but the iatrogenic mortality, morbidity, treatment time, and hospitalization are significantly reduced.

"C" arm guidance in interstitial brachytherapy of pelvic malignancies.

Since 1979 more than 50 transperineal interstitial implants, both removable and permanent, have been performed at the University of Nebraska Medical Center. The "C" arm of the mobile image-intensifier television unit Siemens Mobile 2 was used to guide the placement of the needles and was found to be useful in achieving accurate implantation.

Fluoroscopy guided transperineal percutaneous permanent 125iodine implantation of prostate cancer.

The transperineal percutaneous template permanent iodine interstitial brachytherapy under "C-arm" fluoroscopic guidance is a simple, easily-learned, accurate and rapid procedure which can be performed without subjecting the patient to celiotomy. We have treated 58 patients by the transperineal percutaneous permanent interstitial brachytherapy. The use of transperineal percutaneous technique with C-arm fluoroscopic guidance improves the symmetry and dosimetry of the implant. This results in reduction of the incidence of chronic radiation-induced complications. In the group of 22 patients who underwent brachytherapy without celiotomy and lymphadenectomy and without adjuvant external-beam radiotherapy, there were no major complications.

Retreatment of recurrent pelvic tumors with iodine-125.

We describe our experience with successful retreatment of common pelvic tumors including recurrent cervical and endometrial cancer, colorectal cancer, and soft tissue sarcomas. Two different permanent interstitial 125iodine (125I) endocurietherapy (ECT) techniques were employed. The first technique, percutaneous transperineal template 125I ECT, was used in the retreatment of recurrent tumors located within the true pelvis. The second technique, implantation of 125I in Vicryl carrier following celiotomy, was used for retreatment of recurrent tumors located outside the true pelvis within the false pelvis.

Reaction of the urinary tract to polypropylene sutures.

Cystotomies were performed on 99 mature guinea pigs and closed with polypropylene sutures. The bladders were removed at intervals from day 4 through day 144 postoperatively. They were studied with both light and electron microscopy. A localized mild, acute, inflammatory reaction was noted transitorily; it subsided between the 7th and 14th day. Three calculi were formed, a result which compares favorably with studies of other sutures. Results indicate that the suture may have a place in urologic surgery, but further studies are necessary before clinical use.

Staghorn calculi in children.

Nineteen children who underwent extensive nephrotomies and anatrophic nephrotomies for staghorn calculi (bilateral in 4 cases) are presented. Proteus infection was the cause of the calculus in most cases. In the absence of recurrent stones, renal growth and function were excellent post-operatively. Stone recurrence was minimal if all calculi were removed and infection was controlled. Followup ranged from a few months to 13 years.

Cryptorchidism: incidence of chromosomal anomalies in 50 cases.

We studied testicular tissue and peripheral blood samples for chromosomal anomalies in 50 consecutive patients who underwent orchiopexy. Of the 50 subjects 48 demonstrated karyotypes of 46XY in blood and testicular tissue, 1 had Klinefelter's syndrome and 1 had mosaic trisomy 8 with a discrepancy between the blood and testicular chromosomal complement. Over-all, the study showed no significant discrepancy between the chromosomal complements of the testicular tissue and blood. The incidence of these anomalies is not statistically significant compared to the observed frequency of chromosomal anomalies in this age group.

Chitosan: effects on wound healing in urogenital tissue: preliminary report.

We conducted a survey of the effect of chitosan on wounds of the genitourinary system in dogs. Wounds were made in the kidney, ureter and penile foreskin. Chitosan caused no adverse effects on urogenital wound healing. A decrease in fibrosis was seen in the wounds treated with chitosan in all tissues studied. These observations suggest that the morbidity of urogenital surgery may be decreased by treating the wounds with chitosan.