The Transparency of Irrigation Fluids Used in Endoscopic Surgery.

PURPOSE: Transurethral surgery has been traditionally done using the nonelectrolyte, isotonic 1.5% glycine solution as irrigation fluid. The emergence of modern technologies, which can be applied with electrolyte solutions, such as bipolar resection and LASER evaporation, as well as the worry of transurethral resection (TUR) syndrome have driven urologists away from glycine toward the use of physiologic solution. Differences in the transparencies of these fluids have not been studied. MATERIALS AND METHODS: The ability to resolve two bars at 1 mm apart using a 30° cystoscope lens immersed in different solutions was studied. Physiologic solution, distilled water (DW), and 1.5% glycine solutions containing increasing concentrations of blood, from 0.5% to 2%, were tested. Solutions containing 2% blood were inspected with magnification and microscopy. RESULTS: One-millimeter resolution was reached in as much as 2% blood in 1.5% glycine solution and as much as 1% blood in DW, but in none of the blood-saline solutions. Magnified and microscopic views of 2% blood solutions showed an even distribution of red blood cells (RBCs) in physiologic solution, clumps of RBCs in 1.5% glycine, and an almost complete hemolysis in DW. CONCLUSIONS: Glycine solution increases the transparency compared to physiologic solution or DW owing to the clumping of RBCs. When the risk of TUR syndrome is low, as in resection of bladder tumors or small prostates, we propose that 1.5% glycine solution should be preferred over saline, owing to its improved visibility.

Superiority of the VQZ over the tubularized skin flap and the umbilicus for continent abdominal stoma in children.

PURPOSE: Stricture prevention, avoiding exposed mucosa and cosmesis are important considerations when constructing continent abdominal stomas. We analyzed our results of continent abdominal stomas using the umbilicus and 2 types of lower abdominal stomas, that is the V-quadrilateral-Z technique and the tubular skin flap. MATERIALS AND METHODS: Patient charts were reviewed retrospectively. All patients with a continent abdominal stoma were included in our study. Patients were divided into 3 groups according to type of stoma, including umbilicus, tubular skin flap and V-quadrilateral-Z. The groups were compared regarding demographics, etiology, success, complications and the need for revision. RESULTS: A total of 40 incontinent patients were included in our study. All underwent Mitrofanoff urinary diversion (37) and/or Malone antegrade continence enema construction (13) between 1993 and 2007. The umbilicus was used for 31 conduits, the V-quadrilateral-Z was used for 8 and the tubular skin flap was used for 11. Patient age and gender, and the etiology of incontinence were similar in the 3 groups. All patients achieved good cosmesis with a hidden bowel mucosa. In the V-quadrilateral-Z group no patient had stomal stenosis. Five patients (45%) in the tubular skin flap group required dilation or revision for obstruction or stenosis, which was successful in 4. Eight umbilical conduits (25%) had to be dilated or revised due to stomal stenosis (6) and conduit obstruction (2). CONCLUSIONS: Initial results with the V-quadrilateral-Z flap show its superiority over the tubular skin flap and the umbilicus for stomal construction in patients with a Mitrofanoff or Malone antegrade continence enema conduit.