C. Paul Hodgkinson

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Trocar suprapubic cystostomy for postoperative bladder drainage in the female

Abstract A comparative study in 98 patients was carried out to determine the value of trocar suprapubic cystostomy as a means of postoperative bladder drainage versus bladder drainage by transurethral catheter. With the initiation of voiding on the fifth postoperative day, the patients were taught a do-it-yourself technique of stopcock management which included measuring and recording the volumes of voided and residual urine. Transurethral catheterization was completely eliminated. Of all techniques, the trocar cystostomy procedure had the lowest incidence of “significant bacteriuria,” the shortes hospital stay, and the lowest incidence of morbidity. No major technical complications occurred; minor complications consisted of intravesical bleeding, wound infection, and subcutaneous hematomas. Retropubic urine extravasation and fistula formation were not observed. With the elimination of postoperative catheterization, the trocar cystostomy technique simplified and shortened nursing care. Patients were enthusiastic to be saved the discomfort of repeated catheterization. Although these preliminary results do not permit the making of conclusions as to the relative merits of trocar suprapubic cystostomy, our experience has been sufficiently gratifying as to encourage its continued use.

Iatrogenic bacteriuria and gynecologic surgery: A basic study on incidence, prophylaxis, and therapy

Abstract A prospective study of bacteriuria following gynecologic surgery in 303 patients was undertaken. Well established modes of treatment as well as a new technique of treatment were evaluated and compared. The increased incidence of bacteriuria following catheterization was confirmed. Prophylactic systemic antibiosis not only proved ineffectual in 90 per cent of the patients, but also resulted in untoward side effects in a significant number of patients. Fifty-one patients (17 per cent) were found to have significant bacteriuria preoperatively. This finding indicates the need for adequate preoperative evaluation therapy. Local bladder antibiosis proved more effectual in preventing and treating bacteriuria than prophylactic systemic therapy. Of the two local techniques used, bladder flux was most effective.

Fetal kidney as a source of renin in the pregnant dog

Abstract In a study involving anephric dogs, plasma renin values in the nonpregnant dogs essentially fell to nondetectable levels within 48 hours, while in the pregnant animals detectable renin values were observed through 72 hours. Also, high renin concentrations were found in renal extracts of the fetuses of the nephrectomized dogs. These data suggested that under the stress of maternal bilateral nephrectomy renin from the uteroplacentofetal complex does augment and perhaps compensate for maternal renin deprivation. Whether or not other maternal pathologic states of pregnancy can provoke a similar response cannot be determined from this work. If the source of renin from the uteroplacentofetal complex can be proved to come mainly from the fetal kidney, the question will still remain as to whether or not there is a direct relationship between degrees of fetal maturity, total fetal renal mass, and renin production.

Infravesical nerve resection for detrusor dyssynergia. The Ingelman-Sundberg operation.

In 1959 a paper was published in Acta Obstet Gynecol Scand (38: 487, 1959) by Axel Ingelman‐Sundberg (1) entitled “Partial Denervation of the Bladder—a new operation for the treatment of Urge Incontinence and similar conditions in women”. The basis for the operation was stated in the initial sentence: “The function of an autonomous neurogenic bladder is usually superior to that of a neurogenic bladder, where higher centers are still partially in function.” His operation consisted of transection of the preganglionic pelvic nerves near the inferior surface of the bladder and involved division of both the sympathetic and the parasympathetic nerves.

Stress urinary incontinence in the female

Abstract The urethras of 164 women were measured 496 times. Three methods of measurement were compared. Direct and radiographic measurements with a Foley catheter resulted in specious and inconsistent impressions of shortening because the urethra telescoped over the catheter. The metallic bead chain method of mensuration was deemed most satisfactory because distortion of the urethra did not occur but measurement was approximate because of variable bead distribution; the error was estimated to be within the range of plus or minus 5 mm. No correlation between incidence, severity, or cure of stress urinary incontinence and a short urethra could be demonstrated.

Urethrovesicopubic relationships and urinary stress incontinence: IV. The uterine suspension syndrome

Abstract Anterior displacement of the bladder, imprint of the uterus upon the posterosuperior surface, and partial elimination of the segment of bladder posterior to the urethrovesical junction, are three abnormal alterations in urethrovesicopubic relationships. They occur as the result of extravesical pressure. First observed after uterine suspension, these relationships have been noted to occur also in association with pelvic tumors. They stand out in contrast to the usual downward and backward rotatory changes incident to parturition. Urinary stress incontinence may accompany either type of change. It is the purpose of this report to evaluate the importance of the anatomic changes which occur as the result of posterosuperior extravesical pressure.

Ovarian carcinoma—Perspective for the 70's

Abstract At the beginning of the 1970 decade, the outlook for patients who develop carcinoma of the ovary is almost as bleak as it has been in the past. Delayed diagnosis, a primary inherent tendency for ovarian cancer cells to exfoliate, and an inadequate response to surgical and radiation therapy have combined to relegate carcinoma of the ovary to the position of the killer of more adult women than any other type of female genital malignancy. The faint promise of improvement from chemotherapy has led to fragmentation of the administrative authority over treatment for the ovarian cancer patient with a shift to the medical oncologist. Currently, the patient with ovarian cancer is best served by a cooperative treatment plan which involves pathology, radiology, gynecology, and medical oncology. These objectives can best be accomplished by the recognition of an intraspecialty grouping identified as “gynecologic oncology.”

Basic pressures of voiding in the adult female

Abstract Basic extravesical and intravesical pressure changes involved in voiding were discriminated by simultaneously electronically recording intravesical, intraurethral, and intrarectal pressures in 65 adult females. Voiding was initiated by Valsalva stress in 39 per cent, by detrusor contraction in 33 per cent, and by mixed pressures in 28 per cent. Once voiding was established, the pressure of Valsalva stress frequently dropped out, leaving the evacuation phase of voiding to detrusor contraction. After-voiding contractions occurred as frequently from Valsalva stress as from detrusor contraction. Four patients with chronic partial urinary retention presented evidence which suggested that the etiology might have been due to intense psychic trauma incidental to vaginal plastic surgery. A precise mechanism of voiding for the adult female could not be established. Willful control over detrusor function was confirmed.

Basic surgical training of the gynecologist-obstetrician

Abstract An animal research laboratory is being used to give experience in the basic surgical techniques to the residents in gynecology and obstetrics at The Henry Ford Hospital. Intestinal operations, ureter and bladder operations, vascular repair, research, and cardiac resuscitation are all supervised during a 4 month portion of the residency. Ability and confidence are improved as basic techniques are mastered.