Effect of patient positioning on urethral mobility: implications for radical pelvic surgery.

Patient positioning is of critical importance in the successful performance of several radical pelvic operations. Adequate exposure of the prostatic apex is vital in ligating the dorsal vein complex and performing vesicourethral anastomosis. To test the effect of different patient positions on urethral mobility, we conducted a prospective controlled study measuring the relative cephalad displacement of the prostatic apex in 3 positions, that is the supine, frog-leg and dorsal lithotomy positions. A combination of radiographic and cystoscopic techniques was used to mark the position of the prostatic apex. Each patient served as his own control. Of the 24 patients studied for a variety of urological complaints 19 (79%) had an increased cephalad displacement of the prostatic apex while in the frog-leg position compared with the dorsal lithotomy position. The mean gain was 0.5 cm. (p greater than 0.5). A total of 16 patients showed improvement while in the frog-leg position over the supine position with a mean advantage of 0.39 cm. (p greater than 0.05). Patient age, pelvic depth, pelvic circumference and prostatic urethral length had no predictive value in selecting an optimal position.

Anastomotic strictures following radical prostatectomy: risk factors and management.

Stricture of the anastomosis between the bladder neck and membranous urethra after radical prostatectomy can cause significant voiding dysfunction. Of 156 patients undergoing radical prostatectomy for localized prostatic carcinoma 18 had anastomotic stricture for an over-all incidence of 11.5%. The risk factors for anastomotic stricture and the treatment outcome in these patients were analyzed. Excessive intraoperative blood loss, extravasation of urine at the anastomotic site and a prior transurethral prostatic operation significantly contributed to the development of stricture. More than half of the patients did not respond to simple dilation alone. Cold knife incision of the stricture by itself was effective in only 62% of the patients. The remaining patients required periodic dilation to maintain an adequate urine flow. Incision of the stricture with electrocautery resulted in urinary incontinence in all patients.

Scrotal island flap urethroplasty in the management of bulbar urethral strictures.

We describe our experience with 20 patients undergoing 1-stage scrotal island flap urethroplasty for severe bulbomembranous stricture disease. While 16 patients achieved satisfactory results, 4 required revision for recurrent stricture, diverticulum or fistula. Use of hairless skin and aggressive tailoring of the flap are stressed to avoid the common complications of diverticulum, hair ball and stone formation. This highly vascularized pedicle represents a reasonable alternative to staged repair when local tissue scarring is great and free full thickness skin graft viability is questionable.

Management of simple renal cysts during percutaneous nephrostolithotomy.

Simple renal cysts can coexist with renal stones. Percutaneous removal of these stones requires special considerations. We describe the management of 2 patients with this problem and propose a simple logarithm.

Experience with potency preservation during radical prostatectomy. Significance of learning curve.

Potency preservation after radical prostatectomy is relatively new. The efficacy of this procedure has not been widely documented. Twenty-four patients with full potency underwent nerve-sparing radical prostatectomy. A total of 12 patients retained potency after surgery. Analysis of data reveals there is a learning curve in doing this procedure, and once the initial learning phase is over good results can be obtained in a select group of patients.

Study of intravesical mitomycin C in patients with multiple prior occurrences of superficial bladder cancer.

A limited course of intravesical mitomycin C was tested in 12 patients who had at least three, and an average of six, occurrences of superficial bladder cancer, and were at high risk for subsequent recurrences. After intravesical chemotherapy, recurrence rates were significantly less than rates prior to chemotherapy.

Ureteral obstruction by shotgun pellet seven years after injury.

Ureteral obstruction by an extrinsic object is rare. We herein report a case of renal colic caused by a shotgun pellet lodged in the ureter seven years after the injury. Computerized tomography scan and antegrade pyelogram demonstration were obtained.