Biomedical subjects
Publications and source records attributed to J J Weinberg.
Between May 1989 and October 1989, 24 women underwent a prospective, randomized study comparing polypropylene (Prolene) and polytetrafluoroethylene (Gore-Tex) sutures for endoscopic bladder neck suspension. Polypropylene was associated with significantly more suture pain than polytetrafluoroethylene. Polytetrafluoroethylene was more difficult to tie at a predetermined tension.
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Extrapulmonary tuberculosis has been noted to occur frequently in patients with the Acquired Immunodeficiency Syndrome (AIDS). Tuberculous liver abscesses are rare. The following case report describes a patient with Human Immunodeficiency Virus (HIV) antibody who exemplifies this unusual manifestation of mycobacterial infection.
The Rigiscan machine was used to measure nocturnal penile tumescence and rigidity in 41 men referred for evaluation of erectile impotence. In 6 patients, the Rigiscan was compared with the Tumistore and Snap-Gauge bands. Two patients achieved significant tumescence as measured by Tumistore, and 3 had significant tumescence as indicated by the breaking of two or three of the Snap-Gauge bands. None of these men achieved sufficient rigidity for intercourse as measured by the Rigiscan. Fourteen patients with organic impotence received intracorporeal injections of papaverine and were then monitored by Rigiscan. Six of the 14 were noted to have a Peyronie plaque. Of the remaining 8, 6 of these men achieved lasting erections sufficient for intercourse. The other 2 had erections that lasted ten minutes and were considered to have venous leak impotence. All patients with Peyronie disease had tumescence after papaverine injection, but in 5 the penis became rigid only at the base. Complications of papaverine injection were uncommon and minor. The Rigiscan and papaverine are useful in the diagnosis and management of erectile impotency.
Over the past 10 years, endourology and ureteroscopy have revolutionized the field of urinary endoscopy. No longer limited to cystoscopic examination of the lower genitourinary tract, endoscopy incorporates the upper tracts as well. With this surge in upper tract endoscopy has come a rise in the variety of medical instruments available to the endourologist. Beginning with rigid instruments that offered only a limited view, technology has advanced both flexible and rigid instruments that allow access to the entire urinary tract for examination and treatment. Lenses have been designed to give a clearer and wider view of the kidney and ureter, and forceps and graspers have been developed to treat the underlying pathologic conditions. Stents, wires, and nephrostomy tubes have been developed to keep the urinary system patent and readily accessible for reexamination. It is only through the continuous improvement of these instruments that endourology has advanced in the frontier of urologic surgery.
Ureteroscopy, once the province of experienced endourologists, is now being done routinely by nearly all urologists. Thorough preoperative evaluation, proper selection of instruments, and gentle manipulation will lead to stone retrieval with minimal sequelae.
All endourologic instruments must be handled properly if they are to continue to function properly. Care must be taken in washing and sterilizing of this equipment, as not all endoscopic equipment can endure all methods, and people who are working with these instruments must be taught the proper care and sterilization methods of each. For example, fiberoptic telescopes and light cables must never be autoclaved; ethylene oxide is the method of choice. Disinfectant is an alternative. Loops, sheaths, high-frequency cables, resectoscopes, and working elements should be sterilized by ethylene oxide. Loops and high-frequency cables should not be soaked in a disinfectant, but other instruments may be soaked. All instruments should be dried before sterilization. Too much emphasis cannot be placed on the importance of proper storage of these very fragile fiberoptic instruments. With proper care and sterilization, these instruments will need fewer repairs and function properly for a longer time.
During the last 4 years we performed ureteroscopy for diagnostic evaluation in 20 patients and for removal of mid or distal ureteral stones in 127. All of the diagnostic studies were successful. In the stone removal cases the success rate increased from 71 per cent for the 24 procedures done during the first 2 years to 92 per cent for the 60 procedures done in the first 9 months of 1985. The rate of ureteral injury in the entire series was 2 per cent and in only 9 of the 23 failures was an open operation necessary. The benefit of experience also was evident in the results reported by 28 medical centers, with a 78 per cent success rate at the 11 centers that had performed less than 20 procedures each and an 84 per cent success rate at the 9 centers that had done more than 50. Despite early frustration with ureteroscopy, the value of mastering the technique allows the urologist to proceed endourologically with minimum morbidity and without precluding further interventional procedures.