Norman E. Peterson

Lidocaine as topical anesthesia for bladder mappings and cold-cup biopsies

We describe the use of lidocaine as a topical anesthetic for 35 patients undergoing random bladder biopsies (bladder mappings) and cold-cup resection of small bladder lesions. Serum lidocaine levels were measured 7 to 10 minutes after instillation of the anesthetic using fluorescent polarization immunoassay. Adequate pain control was noted in 33 of 35 patients (94%), with negligible serum lidocaine levels noted in all 35. One patient had a 2 cm. tumor on the anterior wall of the bladder making resection with topical anesthesia suboptimal and 1 patient required 1 mg. supplemental intravenous midazolam hydrochloride to complete the procedure. We conclude that topical lidocaine is a safe, inexpensive and effective mode of anesthesia for bladder mappings and cold-cup biopsies of small bladder lesions. However, it may be inadequate for lesions large enough to require resection rather than cold-cup biopsy and those at poorly accessible regions of the bladder.

Genitoperineal Injury Induced by Orthopedic Fracture Table

Reduction and fixation of lower extremity fractures commonly involve use of the orthopedic fracture table, with incorporation of the perineal post for positioning and countertraction. Prolonged application of perineal pressure thereby is possible, with vulnerability to genitoperineal injury. Four examples are described.

The Significance of Delayed Post-Traumatic Renal Hemorrhage

An impression is presented pertaining to the significance of delayed recurrent post-traumatic renal hematuria, documented by 3 case reports and an appraisal of relevant data selected from prior reports. Adjunctive features may include prolonged initial hematuria despite acceptable radiographic features, a preponderant relationship to penetrating (knife and low velocity missile) wounds and a tendency to respond temporarily to conservative management.

Apparent exceptions to the usual patterns in renal trauma.

Selected cases of renal injuries illustrate the impression that clinical exceptions often may reflect errors in diagnostic interpretation and reaction rather than actual complications, rendering a policy incompetent or dangerously unreliable. These cases, as well as a comparison of debates regarding the management of renal trauma, are intended to offer further encouragement to a non-operative approach to injuries of intermediate degree.

Spermatic Cord for Onlay Coverage of Urethral Defect

Segmental urethral necrosis may accompany scrotoperineal gangrene, and primary closure of the urethral defect may unacceptably reduce urethral dimensions. This dilemma has been managed successfully in 5 patients by application of the intact spermatic cord to the urethral defect and approximation to its margins. A representative case is described.