Demetrius H. Bagley

Flexible ureteropyeloscopy: diagnosis and treatment in the upper urinary tract.

Flexible ureteropyeloscopy was performed on 59 patients with 2.7, 3.2 or 3.6 mm. endoscopes with a deflectable tip. Techniques for use of these flexible endoscopes are discussed in detail. The endoscope could be passed into the ureter in 58 patients and into the kidney in 52 (88 per cent). The entire collecting system was visualized in 23 of the most recent 29 patients (79 per cent). A diagnosis was achieved in all 23 patients with an intrarenal filling defect demonstrated radiographically. The source of gross hematuria alone could be defined in 9 of 17 patients. Surveillance for tumor was achieved in 5 of 5 patients and for residual calculus in 4 of 4. The endoscope was used to establish continuity successfully in 3 patients with an obstructed ureteropelvic junction. An instrument with a deflectable tip and some technique for irrigation are essential for intrarenal inspection and complete visualization of the ureter. This procedure is valuable in selected patients and it rapidly may become the technique of choice for the diagnosis of intrarenal filling defects. It also is of value in patients with benign, essential hematuria.

Transurethral removal of large ureteral and renal pelvic calculi using ureteroscopic ultrasonic lithotripsy.

Transurethral ultrasonic fragmentation of stones allows successful endoscopic removal of upper urinary calculi that otherwise would be considered too large to extract. We successfully extracted endoscopically 2 large renal pelvic and 5 large ureteral stones using transurethral ureteropyeloscopy and ultrasonic lithotripsy. The stone is visualized first with the ureteropyeloscope, and then engaged in a basket and either fragmented or disintegrated with the ultrasonic transducer. Any remaining small stone fragments can be retrieved with a stone basket or forceps. There has been little morbidity with this procedure and patients can return to normal activity after discharge from the hospital.

Ureteroscopy and ureteropyeloscopy

Transurethral endoscopic access to the upper urinary tract using rigid optics is evolving into a significant addition to the specialty of urology. The basic endoscopic expertise urologists have perfected for use in the urethra, prostate, and bladder is readily transposed to the ureter and renal pelvis. Indications, precautions, instrumentation, and procedural techniques are detailed.

Treatment of distal ureteral calculi using rigid ureteroscope

Abstract Rigid transurethral ureteroscopy has been utilized on sixteen occasions for the treatment of distal ureteral calculi. This resulted in successful stone removal and avoidance of an open operation in 69 per cent of the cases. The advantages of this type of treatment are that it enables endoscopic access to a surgically difficult portion of the ureter and allows direct visualization during basket manipulation of ureteral calculi.

Combined Rigid and Flexible Uretergpyeloscopy

The development of rigid and flexible ureteropyeloscopes has provided the means for direct visualization of the upper urinary collecting system. Each instrument has its own advantages and disadvantages. The combined use of these instruments extends the range of endoscopy throughout the intrarenal collecting system, permits irrigation and provides a working channel.

Selective surface staining of bladder tumors by intravesical methylene blue with enhanced endoscopic identification

Intravesical instillation of methylene blue resulted in selective surface staining of bladder tumors in vivo without staining the background of normal urothelium. Staining of human bladder tumors in vivo was accomplished by the intravesical instillation of 0.1% methylene blue in 0.9% saline through a foley catheter under 20 cm of hydrostatic pressure up to a maximum volume of 400 ml. After 5 minutes contact time, the methylene blue solution was drained, and the bladder was washed with saline. Thereafter, either endoscopic or open surgery was performed. The transitional cell carcinomas in 45 of 48 patients bound methylene blue to the surfaces of the tumors but not to normal urothelium. Higher grade tumors usually bound the dye more extensively than lower grades. The three patients, whose tumors did not bind methylene blue, had received previous chemotherapy, which might account for their being falsely negative. Carcinoma in situ and dysplasia did stain blue. Areas of hyperplasia and cystitis, however, did not bind methylene blue. In vivo intravesical staining with methylene blue has been a simple and safe procedure which has enhanced the endoscopic localization for biopsy and fulguration/resection of transitional cell carcinomas.

Endoscopic ureteropyelostomy: opening the obliterated ureteropelvic junction with nephroscopy and flexible ureteropyeloscopy.

Endoscopic re-establishment of a totally obstructed ureteropelvic junction was accomplished in 2 patients. The combined use of rigid percutaneous nephroscopy and flexible ureteropyeloscopy provided full visualization of the obliterated segment, and allowed accurate electroincision into the ureter and placement of a wire and catheter into the lumen. This technique demonstrates the potential therapeutic applications of flexible ureteropyeloscopy and should be considered for the initial treatment of the obliterated ureteropelvic junction.

Atraumatic perforation of bladder: Necessary differential in evaluation of acute condition of abdomen

Perforation of the urinary bladder without history of antecedent trauma is a rare clinical occurrence. However, in patients with acute conditions of the abdomen, especially those with previous voiding symptoms, the diagnosis should be considered. Three cases are reported. Patients presented with an atraumatic bladder perforation and peritonitis secondary to chronic inflammation, bladder outlet obstruction, and transitional cell carcinoma. After review of the literature, a classification of atraumatic bladder perforation has been revised to include presently available reports of this entity.

In Vivo Urothelial Surface Histology by Microscopic Chromocystoscopy

Microscopic chromocystoscopy is a new in vivo procedure that we have developed to aid in the detection and treatment of bladder tumors. Intravesical ionic dye chromocystoscopy was introduced by our group to permit cystoscopic viewing with ordinary light of selectively stained malignant urothelial surfaces by the cationic dye, methylene blue. With the recent availability of the Hamou hysteroscope, a microscopic endoscope, we have combined intravesical ionic dye chromocystoscopy with microscopic cystoscopy to give in vivo urothelial surface histology, with resolution of cytological detail. We herein describe our new method and preliminary results with this procedure, which we have designated in vivo urothelial surface histology by microscopic chromocystoscopy.

Intraoperative Real Time Ultrasonic Scanning for Locating and Recovering Renal Calculi

Intraoperative ultrasonic guidance is a useful method to locate and to remove small renal stones broken from a larger stone during extraction, stones and calices proximal to a narrowed infundibulum and parenchymal calculi that should be removed during other procedures on the kidney.