Walter S. Kerr

Arteriography in the Management of Hemorrhage from Pelvic Fractures

Abstract Localization of the source of massive hemorrhage from pelvic fractures is not often made clinically, and the results of expectant management or of hypogastric artery ligation are frequentl...

Ureteroscopy: The Initial Experience

A prospective study of our first 81 cases of ureteroscopy using extended length rigid endoscopes was performed. Of 55 stone manipulations attempted in 51 patients by 6 endoscopists 38 (69 per cent) were successful. Analyzed sequentially, removal was successful in 12 of 23 attempts (52 per cent) among the initial 40 patients and in 26 of 32 (81 per cent) among the subsequent 41 patients. Of 11 calculi larger than 1 cm. and of 23 positioned above the iliac vessels 7 (64 per cent) and 11 (48 per cent), respectively, were removed successfully. Disimpaction by ureteroscopic manipulation combined with extracorporeal shock wave lithotripsy was successful in 4 cases of upper ureteral calculi not treatable by extracorporeal shock wave lithotripsy alone. Diagnostic and therapeutic uses of the ureteroscope in addition to treatment of ureteral calculi have included the delineation of ureteral filling defects (9 patients), fulguration of known low grade tumors (4) and dilation of ureteral strictures (5). In 10 patients information was obtained endoscopically that was not possible by standard diagnostic techniques. The direct visual approach to the ureter has distinct advantages over blind ureteral instrumentation.

Control of Massive Prostatic Bleeding with Angiographic Techniques

In the 4 cases reported herein angiographic techniques with selective bilateral hypogastric embolization were used to control severe prostatic hemorrhage. The technique is offered as an alternative, non-operative procedure in the management of bleeding when other modes of therapy contain significantly higher potentials for morbidity and mortality.

Angiographic Management of Bleeding Secondary to Genitourinary Tract Surgery

Angiographic methods were applied to control bleeding in 2 patients following genitourinary tract operations. In 1 patient hemorrhage into the prostatic bed after needle biopsy of the prostate was controlled with embolic occlusion of branches of the hypogastric arteries. In the second patient bleeding from the ileum following ileal loop cutaneous diversion was controlled with the infusion of vasopressin into the superior mesenteric artery. Therefore, angiography offers an attractive alternative to an operation in the management of postoperative hemmorrhage from the genitourinary tract.

The Role of Arteriography in the Management of Renal Cell Carcinoma Associated with Von Hippel-Lindau Disease

AbstractRenal cell carcinoma was detected in 5 patients with von Hippel-Lindau disease most accurately by magnification arteriography. At an operation aided by arteriography 80 to 100 per cent of the lesions, some measuring only a few millimeters, could be removed. The patients were followed by serial arteriography every 6 to 12 months to assess the size of remaining lesions and the development of new lesions. Re-exploration was considered if there was rapid growth or an increase in size of more than 1cm.

Autosuturing device in intestinal urinary conduits

The autosuturing device has been used to close the base of 41 urinary intestinal conduits: 12 colonic, 25 ileal, and 4 jejunal. The techniques are described. There were no urine or bowel leaks, although in one postoperative gastrointestinal bleeding occurred in association with a partial small-bowel obstruction probably related to the stapled enteroanastomosis. Use of the instruments reduced peritoneal contamination and facilitated conduit manipulation. Operating time was reduced. Four patients have passed stones composed of struvite and apatite with staples embedded within. The autosuturing device should be considered an alternative rather than a substitute for conventional proximal conduit closure and bowel anastomoses.

Segmental calculus disease: Potential of partial nephrectomy☆

Partial nephrectomy was performed on 71 renal units between 1962 and 1978 for segmental calculus disease. Parenchymal scarring associated with an infundibulocalyceal stone, which was usually branched, was the indication for resection. Stone analysis demonstrated an equal incidence of idiopathic and struvite stones. Perioperative morbidity was minimal, but pyelocutaneous urinary drainage prolonged the hospitalization of 5 patients. In 2 cases, the cause was an obstructing retained calculus. Retained calculi occurred in 3 other patients, one requiring early nephrectomy for sepsis. Fifty-seven patients were followed for longer than twelve months. Ipsilateral calculi recurred in 12 per cent of kidneys, and contralateral new calculi developed in the same number. Ninety-four per cent of patients with preoperative urinary tract infections had sterile urine at follow-up. From the results of this and other series, partial nephrectomy compares favorably with extended pyelolithotomy and anatrophic nephrotomy for segmental calculus disease associated with parenchymal scarring and/or a deformed collecting system.