Alexander S. Cass

Electrical stimulation for incontinence: Technique, selection, and results☆

Incontinence due to hyperreflexic bladder and/or pelvic floor weakness can be corrected by chronic functional electrical stimulation (FES). Cystometry, electromyography of pelvic floor muscles, and anal sphincter pressure measurements with and without electrical stimulation determines if chronic FES will be successful. Post-acute stimulation improvement occurred in patients with incontinence due to hyperreflexic bladder and/or pelvic floor weakness. A success rate of 92 per cent was achieved with chronic FES in incontinent patients with this method of selection.

Renal Trauma in the Multiple Injured Patient

Immediate radiological evaluation of renal injuries by a large dose or infusion excretory urogram resulted in a definitive diagnosis in 87% of the cases. Further radiological evaluation or exploration was required to make a definitive diagnosis in the remaining 13%. Blunt external trauma was responsible for 94% of the renal injuries. Less morbidity and a sharp reduction in delayed renal operation followed the introduction of immediate surgical management with the more severe types of renal injury. Clamping of the renal vessels prior to opening Gerotas fascia prevents reactivation of hemorrhage and allows for a deliverate operation with conservation of undamaged renal tissue. Associated injuries were present in 73% of the patients, including intra-abdominal injuries in 42%. The over-all nephrectomy rate of 5% in this study compares favorably to the nephrectomy rate in studies reporting the expectant management of renal injuries.

Recanalization following vasectomy

Abstract Most authors have not differentiated between early and late recanalization following bilateral vasectomy for sterilization. Their reported recanalization rates probably reflect only early recanalization. Long-term follow-up semen examinations are required to document late recanalization. This regimen may be unacceptable to some patients and physicians. No symptomatic postvasectomy complication preceded the recanalization.

Renal trauma and preexisting lesions of kidney.

Abstract Preexisting lesions of the kidney with renal trauma were present in 15.4 per cent of children and 4.4 per cent in the all-age group. Half of these lesions were hydronephrotic kidneys while cyst, tumor, and abnormal position were found with much reduced frequency. When a minor injury results in renal trauma, evaluation must exclude an underlying preexisting lesion of the kidney.

Comparison of ligation and fulguration methods

Abstract Bilateral vasectomy for sterilization using the electrofulguration technique has resulted in no early recanalization of the vas deferens, whereas recanalization did follow the vas ligation method. The operative discomfort and morbid state with minor wound complications were higher with the fulguration method than with the ligation method.

Comparison of Bricker and Wallace Methods of Ureteroileal Anastomosis in Urinary Diversions

Urinary diversion, as described by Bricker in 1950 was for use in adults who required pelvic exenteration for cancer. In this procedure, a 10 to 20 cm length of terminal ileum is isolated from the intestinal tract, and the continuity of the bowel re-established by open end-to-end anastomosis. The appendix is removed. The proximal end of the detached segment of ileum is closed. The ureters are divided from the bladder and anastomosed to the ileal segment, near its blind end through openings in the ileal wall cut to the exact size of each ureter. The distal end of the ileal segment is brought out to the surface of the abdomen in the right lower quadrant through a circular opening cut through skin, fascia, muscle and peritoneum and sutured to the skin to form a slightly protuberant ileal stoma. The various complications encountered with this procedure have prompted the introduction of several modifications. The Wallace method of ureteroileal anastomosis (1966) consists of splaying the distal ureters longitudinally. The medial edges are sutured together with a continuous 5-zero chromic catgut suture. The conjoined ureters are then sutured to the proximal ileal segment with a 4-zero chromic catgut suture at the apex of each ureter to the ileum and a continuous 5-zero chromic suture along the lateral edges. The entire anastomosis is retro- peritonealised. The ileal conduit is brought through the peritoneal cavity to the anterior abdominal wall where a stoma is constructed.

Bladder diverticulectomy. With aid of inflated Foley balloon catheter.

Abstract A technique of bladder diverticulectomy using an inflated Foley catheter is described.

Congenital megacalyces associated with Hirschsprung's disease

Abstract A case of bilateral megacalyces and associated Hirschsprungs disease is presented. The possibility is raised of these two diseases having a common neuromuscular congenital origin.

Medial deviation of ureters Following abdominoperineal resection for carcinoma of large bowel

Abstract Bilateral medial deviation of the ureters occurred in 11 of 21 patients following abdominoperineal resection for carcinoma of the lower segment of large bowel. Recurrent pelvic carcinoma rather than surgical causes was responsible for the deviation in most of these patients.

Acute nonobstructive pyelonephritis requiring nephrectomy.

Abstract A case of severe acute nonobstructive pyelonephritis in a nondiabetic requiring nephrectomy is reported. The most unusual feature of the pyelonephritis was the spread of the inflammatory process despite intense antibiotic therapy.