Benad Goldwasser

Cystometric Properties of Ileum and Right Colon After Bladder Augmentation, Substitution or Replacement

Cystometric studies were performed on 38 patients who had undergone augmentation, substitution or replacement enterocystoplasty. These studies were done to determine the choice of bowel segment to augment or replace the detrusor and the shape in which the bowel segment should be reconstructed. Eleven patients underwent tubular and 10 detubularized right colon cystoplasty, while 10 underwent tubular (Camey bladder) and 7 detubularized ileocystoplasty. Compliance curves were normal in nearly all patients except those who underwent tubular ileocystoplasty. Cystoplasty contractions were more common with tubular cystoplasty. These contractions appeared at a lower bladder capacity and were higher in amplitude in tubular cystoplasty patients. Detubularizing the bowel for bladder reconstruction appears to create a better low pressure capacitor with better compliance and fewer high pressure cystoplasty contractions.

Ejaculatory duct obstruction: the case for aggressive diagnosis and treatment.

Ejaculatory duct obstruction is considered a rare cause of infertility. Based on the results of treatment in our 5 patients and a review of 14 additional well documented cases we were able to classify these patients prognostically. Whereas congenital and acquired noninfectious obstructions are amenable to a transurethral operation in as many as 57 to 67 per cent of the cases, all obstructions secondary to genital infections failed treatment.

Role of linear tomography in evaluation of patients with nephrolithiasis

One hundred twenty-four consecutive patients with suspected or known nephrolithiasis were referred for evaluation by linear tomography. Renal calculi were detected in 98 patients (79%). Linear tomography revealed more renal calculi than did preliminary KUB films in 46 patients (37%), although in only 10 cases (8%) was the tomogram positive if the KUB was negative. Exact quantification of the numbers and locations of renal stones is important in patients to be managed metabolically, and in those being evaluated in advance of or following percutaneous or extracorporeal lithotripsy.

Factors Affecting the Success Rate of Percutaneous Nephrolithotripsy and the Incidence of Retained Fragments

The medical records of the first 210 patients treated with percutaneous nephrolithotripsy at our university medical center were reviewed. The data were analyzed in an attempt to define those factors that affect the success rate and incidence of retained fragments of these procedures. We found that stone location and extent, and to some degree stone size are the major factors affecting the success rate and incidence of retained stones. Chemical composition of the calculus, history of renal surgery and energy source used for stone removal have lesser roles.

Perineal Transpubic Repair: A Technique for Treating Post-Traumatic Prostatomembranous Urethral Strictures

A perineal, 1-stage, end-to-end anastomotic repair is the preferred method to treat short (2 cm. or less) prostatomembranous urethral strictures. For longer strictures a combined perineal and abdominal transpubic approach is required. We describe a technique that has allowed a 1-stage perineal repair of such strictures, up to 5 cm. long, by wedge excision of the inferior portion of the pubis. This technique has been used in 4 patients with prostatomembranous strictures 2 to 5 cm. long. The results were uniformly good in all of these patients.

Impotence Due To the Pelvic Steal Syndrome: Treatment by Iliac Transluminal Angioplasty

AbstractWe report on a patient with the pelvic steal syndrome who was treated successfully by percutaneous transluminal angioplasty. We have found only 1 such case reported previously.

Results and morbidity of percutaneous nephrolithotripsy

The medical records of the first 210 patients treated with percutaneous nephrolithotripsy at Duke University Medical Center were reviewed. Eleven patients were treated for bilateral stones for a total of 221 renal units. The procedure failed in 6 patients (2.7%). Stone fragments were retained in 55 patients (24.9%), with unplanned fragments in 41 cases (18.6%). Open surgery was subsequently performed in 4 patients (1.8%). There were no nephrectomies or deaths in our patients. Percutaneous nephrolithotripsy is a highly successful method for removal of upper tract stones and has a complication rate no higher than that of open surgical procedures.

Partial nephrectomy using a new dissecting instrument

The kidney is made of friable parenchyma with flexible blood vessels and collecting system structures. A dissecting clamp with interlacing blunt teeth was designed that, by repeated action of closing and opening over the renal parenchyma, crushes and dissects away the friable tissue, leaving the blood vessels and collecting system structures intact. Thus, individual ligation of blood vessels and collecting system structures can be performed at the line of resection. We report our experience in 10 dogs and 1 patient in whom partial nephrectomy was performed with this instrument.

The Effect of Ultrasonic Disintegration on the Outcome of Percutaneous Nephrolithotripsy

Concern has been expressed regarding the use of ultrasonic lithotripsy in the percutaneous treatment of renal calculi with the suggestion that high rates of retained stones may be experienced. Evaluation of 89 patients with stones confined to the renal pelvis treated both with and without ultrasonic lithotripsy were evaluated with regard to stone size, retained fragments, stone composition and previous renal surgery. It is felt that it is not the use of ultrasonic lithotripsy that leads to longer hospitalization and retained fragments, but rather the size of the renal calculi and the complexity of arrangement.