Pyelovenous backflow: implications for coagulum pyelolithotomy and nephroscopy.
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Biomedical subjects
Publications and source records attributed to C P Fischer.
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Simultaneous presentation of obstructing ureteral calculi and untreated primary hyperparathyroidism offers an interesting therapeutic dilemma. We herein review 8 cases, with 6 occurring in the last 3 years. When both conditions require surgical intervention the parathyroid adenoma should be excised first. The adenoma and offending stone can be removed at the same operation, with resultant prompt relief of pain and decrease in hospitalization.
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Human cryoprecipitated plasma can form an extractable coagulum which will effectively remove renal calculi in selected cases. We successfully used this blood product and a simplified injection technique in 30 patients undergoing surgery for upper tract calculi. Coagulum pyelolithotomy was performed in 24 cases with removal of all stones in 23 (96 per cent). In 6 patients incomplete stone removal by conventional operative methods was successfully completed by using the coagulum as an adjunctive procedure. In 10 of the 30 cases (33 per cent) radiographically "silent" calculi were recovered within the cryoprecipitate clot. The advantages of cryoprecipitate over previously reported blood products, certain technical simplifications, and the appropriate clinical indications for the coagulum procedure are discussed.
The effect of infusion height upon intravesical pressure during cystography was studied in three dogs and three patients. Results indicate that during bladder filling the intravesical pressure is independent of the reservoir height.
A fibrin clot forming an extractable cast or "coagulum" of the pyelocalyceal system was developed and characterized using a blood product not previously described--single donor type specific cryoprecipitate. The physical properties of the cryoprecipitate coagulum were investigated and compared with other described formulations. Simulated coagulum pyelolithotomy was performed in vivo in 11 canine kidneys with no adverse effect upon creatinine clearance or anatomic integrity. The advantages of the cryoprecipitate are detailed and a new, simplified operative technique is described.
A renal myoepithelial hamartoma presented as a lucent filling defect with gross hematuria in an adult female. Preoperative studies caused conflicting impressions. The predominance of smooth muscle and incorporated tubuloepithelial elements characterize the tumor as a hamartoma of myoepithelial type. Pertinent review of the literature confirms the rarity of this lesion in adults.
Low dose heparin prophylaxis has proved effective in reducing postoperative thromboembolic complications in a series combining multiple types of surgical procedures. Our series comfirms its safety for transurethral operations. We recommend its use in patients with predisposing factors to thromboembolic complications.
A preliminary study to assess objectively the effects of dicyclomine upon uncontrolled detrusor contractions and bladder capacity was undertaken in 14 patients with a cystometric diagnosis of uninhibited neurogenic bladder. Response was measured by cystometry performed 1, 2 and 4 hours after a 20 mg. oral dose. Of the 14 patients 11 had significant blockade of uninhibited contractions and a concomitant increase in bladder capacity. Similar but less dramatic changes were noted in the remaining 3 patients. Dicyclomine seems to have effective anticholinergic properties. No remarkable side effects were observed.