LETTERS TO THE EDITOR
RESECTOSCOPE FOLLOWER
encountered the problems outlined by the authors: namely, either apparent weakness of the suture line or development of postoperative bladder infections more resistant to treatment than before surgery. Furthermore, we have felt that the advantage of hemostasis of the highly vascular mucosal layer outweighed the potential risk of localized tissue necrosis. The authors have presented an excellent histologic documentation of the extramucosal closure of canine bladders, and undoubtedly the results of their research have clinical significance in humans. However, I would certainly question the advisability as well as the validity of the statement that all mucosal closures of the bladder should be abandoned.
OBTURATOR-
To the Editor:
We commend Bahij S. Azoury, M.D., for his ingenuity in describing his modification of the resectoscope sheath obturator to be used as a follower prior to transurethral surgery in the November issue (vol. 6, page 626) of UROLOGY. However, this clever, practical adaptation of the obturator is, in fact, not truly innovative, since it was Lowrain E. McCrea, emeritus professor of urology at Temple University School of Medicine, who first designed this unique instrument. And, Dr. McCrea’s instrument, which is identical to the one described in his article, antedates Dr. Azoury’s obturatorfollower by almost thirty years. We can attest to the handiness of the McCrea obturator-follower, as members of our department have utilized it to expedite transurethral surgery many times since it was originally fashioned by Dr. McCrea.
Sumner Marshall, M.D. University of California San Francisco, California 94143
Arthur E. Feldman, M.D. Anthony J. Perri, M.D. Temple University Philadelphia, Pennsylvania 19140
BLADDER
CLOSURE
TECHNIQUE
To the Editor:
In their article, “Experimental Evaluation of Bladder Closure Techniques” (UROLOGY, vol. 6, page 194), Dr. Baum, Dr. Scott, and Dr. Isaya have presented a clear, well-executed study on the advantages of the extramucosal running horizontal mattress closure. However, I must take issue with certain aspects of the article. In the first place, I feel that the statement, “Those closure techniques which incorporate . 1 . (the mucosa) shouM be nbandoned” (my italics) is too dogmatic. Pedagogically, such strong wording may be quite effective, but medicolegally, it is risky and likely to stir the aggressive behavior of some of our legal colleagues. Second, and more importantly, in our 300 cases of ureterovesicoplasties, in which the mucosa was included in the bladder closures, we have not
UROLOGY
/ JANUARY 1976 / VOLUME
VII, NUMBER
RETRIEVAL OF INDWELLING URETERAL STENT To the Editor:
Dana C. Neindorf, M.D., and Bernard Kamhi, M.D., are to be congratulated for their successful “Retrieval of Indwelling Ureteral Stent Utilizing Fogarty Catheters,” reported in UROLOGY (Vol. 6, page 622). Despite the presence of the distal flange in these stents,” instances of upward migration have been related to me, particularly when the stent is used in unobstructed ureters. Other means of retrieval in these instances have included the use of a stone basket and flexible forceps passed into the ureter. I would suggest that when these stents are used in nonobstructed ureters, a lo- to 15-cm. length of monofilament suture material be securely tied around the distal end of the stent. Following placement of the stent, the suture material will lie freely in the bladder, similar to the way an IUD string lies in the vagina. Should upward migration occur, the suture remaining within the bladder would permit easy retrieval. Robert P. Gibbons, M.D. 1118 Ninth Avenue Seattle, Washington 98101 *Heyer-Schulte
1
Corporation,
Goleta,
California.
117
RESECTOSCOPE FOLLOWER
encountered the problems outlined by the authors: namely, either apparent weakness of the suture line or development of postoperative bladder infections more resistant to treatment than before surgery. Furthermore, we have felt that the advantage of hemostasis of the highly vascular mucosal layer outweighed the potential risk of localized tissue necrosis. The authors have presented an excellent histologic documentation of the extramucosal closure of canine bladders, and undoubtedly the results of their research have clinical significance in humans. However, I would certainly question the advisability as well as the validity of the statement that all mucosal closures of the bladder should be abandoned.
OBTURATOR-
To the Editor:
We commend Bahij S. Azoury, M.D., for his ingenuity in describing his modification of the resectoscope sheath obturator to be used as a follower prior to transurethral surgery in the November issue (vol. 6, page 626) of UROLOGY. However, this clever, practical adaptation of the obturator is, in fact, not truly innovative, since it was Lowrain E. McCrea, emeritus professor of urology at Temple University School of Medicine, who first designed this unique instrument. And, Dr. McCrea’s instrument, which is identical to the one described in his article, antedates Dr. Azoury’s obturatorfollower by almost thirty years. We can attest to the handiness of the McCrea obturator-follower, as members of our department have utilized it to expedite transurethral surgery many times since it was originally fashioned by Dr. McCrea.
Sumner Marshall, M.D. University of California San Francisco, California 94143
Arthur E. Feldman, M.D. Anthony J. Perri, M.D. Temple University Philadelphia, Pennsylvania 19140
BLADDER
CLOSURE
TECHNIQUE
To the Editor:
In their article, “Experimental Evaluation of Bladder Closure Techniques” (UROLOGY, vol. 6, page 194), Dr. Baum, Dr. Scott, and Dr. Isaya have presented a clear, well-executed study on the advantages of the extramucosal running horizontal mattress closure. However, I must take issue with certain aspects of the article. In the first place, I feel that the statement, “Those closure techniques which incorporate . 1 . (the mucosa) shouM be nbandoned” (my italics) is too dogmatic. Pedagogically, such strong wording may be quite effective, but medicolegally, it is risky and likely to stir the aggressive behavior of some of our legal colleagues. Second, and more importantly, in our 300 cases of ureterovesicoplasties, in which the mucosa was included in the bladder closures, we have not
UROLOGY
/ JANUARY 1976 / VOLUME
VII, NUMBER
RETRIEVAL OF INDWELLING URETERAL STENT To the Editor:
Dana C. Neindorf, M.D., and Bernard Kamhi, M.D., are to be congratulated for their successful “Retrieval of Indwelling Ureteral Stent Utilizing Fogarty Catheters,” reported in UROLOGY (Vol. 6, page 622). Despite the presence of the distal flange in these stents,” instances of upward migration have been related to me, particularly when the stent is used in unobstructed ureters. Other means of retrieval in these instances have included the use of a stone basket and flexible forceps passed into the ureter. I would suggest that when these stents are used in nonobstructed ureters, a lo- to 15-cm. length of monofilament suture material be securely tied around the distal end of the stent. Following placement of the stent, the suture material will lie freely in the bladder, similar to the way an IUD string lies in the vagina. Should upward migration occur, the suture remaining within the bladder would permit easy retrieval. Robert P. Gibbons, M.D. 1118 Ninth Avenue Seattle, Washington 98101 *Heyer-Schulte
1
Corporation,
Goleta,
California.
117
