Roger S. Warner

Treatment of urethral diseases with neodymium:Yag laser

Over a thirty-month period, a wide variety of common urethral problems were treated on an ambulatory basis, with the neodymium:yttrium-aluminum garnet (Nd:YAG) laser. When used discriminately, laser treatment appears to be an effective modality for the management of selected urethral strictures. Thus far, excellent results have been obtained in 30 of 31 cases of short strictures where laser urethrotomy was performed as the first stricture procedure (average follow-up 10 months). Furthermore, in a series of 36 cases of secondary bladder neck contractures, all of the evaluated patients responded well (average follow-up 7 months). Good results were obtained in only 11 of 48 complicated strictures (average follow-up 14 months). However, while most of these extensive strictures were not eradicated, laser therapy generally produced a documented clinical improvement, comparable to urethrotomy or dilatation, in 15 of these cases. A series of 24 condylomata involving the urethra were treated satisfactorily, with no recurrences (average follow-up 13 months). Laser treatment also has been used successfully for the management of several urethral caruncles, urethral polyps, two meatal hemangiomas, one urethral carcinoma, and a distal duplicated urethra. Recently, the Nd:YAG laser has been applied to the prostatic urethra with vaporization of obstructing median bar hyperplasia. Favorable results have been achieved in 5 of 6 cases treated with a newly developed technique that utilizes direct laser contact. Retrograde ejaculation has not been encountered in these patients (average follow-up 6 months). All of these procedures have been accomplished in the office, largely without urethral catheterization. Lidocaine jelly occasionally supplemented with intravenous sedation provided satisfactory anesthesia.

Testicular needle biopsy in diagnosis of infertility

Testicular needle biopsies were performed on 10 patients who at the same time underwent open testicular biopsy. The tracts and puncture sites were explored on each of these patients, and an open biopsy was obtained at the puncture site simultaneously. Both needle specimen and open tissue specimen were fixed in Bouin solution and sent for histologic examination. In none of the cases was there found to be bleeding or extrusion of the testis at the puncture site. In one of the needle specimens, however, insufficient tissue was obtained for diagnosis. In the other 19 specimens, diagnostic accuracy was not compromised by the technique. The main differences appear to be fewer tubules obtained by the needle technique as well as decreased preservation of the interstitial tissue. This is a rapid, simple, and inexpensive method for testes biopsy which has proved to be both safe and diagnostically accurate.

Needle biopsy of testes: A safe outpatient procedure

A total of 287 testes biopsies were performed in the office under local anesthesia, using a modified needle and technique to collect the tissue which was then fixed in Bouins solution. Adequate tissue was obtained in all specimens for histopathologic diagnosis. In 3 patients small hematomas developed and were treated conservatively. Five patients complained of orchialgia, but none required narcotic analgesia. No sperm antibodies, extravasation, or serious complications were encountered. We believe this technique is safe, simple, and cost-effective.

Carcinoid tumor of kidney.

A case of carcinoid tumor of the kidney is reported. Pathologic findings of the tumor, clinical manifestation, and treatment are discussed.

Bladder perforation after orthopedic hip surgery

Abstract A case of a broken pin from previous orthopedic hip surgery which perforated into the bladder is presented. A review of other urologic complications of orthopedic surgery are included.

Endoscopy of ureterointestinal conduits and retrograde pyelography

The ureterointestinal conduits of 15 patients were examined using gastrointestinal fiberoptic instruments and techniques. Retrograde pyelography by direct cannulation of ureterointestinal anastomoses was successful in 5 of 7 attempts. Endoscopic instrumentation of upper urinary passages may ultimately be useful in managing postoperative complications in patients with urinary diversion into intestinal loops.

Transrectal ultrasound in early detection of clinical stage a prostate cancer

A group of 40 select men were studied to assess the value of transrectal ultrasound in the early detection of prostate cancer. All had a benign digital rectal examination and had either irritative lower tract symptoms, hematospermia, microhematuria, or an elevated acid phosphatase. Of the men, 28 had an abnormal ultrasound and underwent a directed prostate needle biopsy to assess the ability to detect clinical Stager A cancer. Eleven men (40%) were found to have cancer, all having hypoechoic lesions. The remainder were found to have benign prostatic hypertrophy (BPH) with hyperechoic lesions predominating (88%). Our results suggest that transrectal ultrasound is a useful and sensitive method for the detection of prostate tumors not clinically evident on digital rectal examination in select patients.

Endoscopy of intestinal urinary conduit

Using flexible gastrointestinal endoscopes, we have examined the urinary intestinal conduits of 15 patients. We have found this to be a reliable, easily performed endoscopic procedure that allows ureteral catheterization when needed. The instrument, technique, and results are described.

Optical urethrotomy as ambulatory procedure

Optical urethrotomy is a relatively new means of treating urethral stricture. We performed the procedure on 100 ambulatory patients using only topical anesthesia and sedation in some. The patients were followed a minimum of one year. Our success rate for cure following one procedure was 66 per cent; however, those patients not cured required less frequent dilations after urethrotomy. We believe that this is a safe and effective means of treating urethral strictures in the outpatient setting with little morbidity and discomfort and with considerable economic savings.

Epitheliuria: Aid in early diagnosis of renal artery embolus

Abstract A study was undertaken to determine if the observation of clusters of epithelial cells seen in the urinary sediment of a patient with acute renal artery embolus could provide a new and simple method of confirming the diagnosis. The urine from 5 dogs surgically infarcted and 3 humans undergoing percutaneous renal embolization for tumor were studied. Clusters of epithelial cells were observed in the urines of these dog and human models suggesting that this may be used as a rapid and easily performed test to confirm the clinical diagnosis of renal artery occlusion.