Biomedical subjects
Publications and source records attributed to R H Hackler.
Coagulum pyelolithotomy has been beneficial in removing calyceal calculi when the diameter of the infundibulum and pelvis is adequate. By utilizing a simple, precise ratio of cryoprecipitate, thrombin, and calcium chloride (25:4:1), an effective coagulum was obtained in 7 consecutive cases with complete stone removal in 5.
Twenty-five patients with traumatic spinal cord injuries above T7 have been managed with low spinal anesthesia during endoscopic urologic procedures. The technique has been completely successful in preventing autonomic dysreflexia and has not been associated with hypotension.
In an effort to determine whether or not urine flow is necessary for proper healing after ureteral reimplantation, a laboratory study was carried out using mongrel dogs. Twelve animals underwent three separate surgical procedures in order to show whether ureteroneocystostomy in the presence of proximal urinary diversion would lead to subsequent stenosis of the reimplantation sites. Our findings indicate that stenosis does not occur regardless of whether or not dry ureteral implants are stented. These studies were carried out in ureters of normal caliber and animals otherwise free of disease. It is our contention that under these circumstances, dry ureteral reimplantation will result in satisfactory healing without stricture or stenosis
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Ileal loop diversion is only considered for persistent or progressive hydronephrosis (failed conservative treatment directed at the bladder). This conservative approach is based on a comparison of our ongoing prospective mortality study on 470 paraplegics plus 175 spinal cord patients that have survived at least 30 years v. an updated literature review of ileal conduits performed for benign disease.
The most common cause of renal deterioration in the spinal cord injured patient is irreversible vesicoureteral reflux. Of 39 unilateral vesicoureteroplasties done for this condition 33 have been successful (85 per cent). Of 51 bilateral vesicoureteroplasties the success rates remain at 55 percent of the patients and 72 percent of the ureters. Since these success rates are possibly acceptable and the complication rate minimal, indications and technique are stressed.
Herein we combine 2 studies: a 25-year prospective followup on 270 spinal cord injury patients and a more than 20-year (average 24.2 years) evaluation of 175 paraplegics. The mortality rate was 49 per cent after 25 years, with renal disease as the major cause of death (43 per cent). Vascular deaths were just as prevalent during the last 5 years of spinal cord life. There are probably several reasons why some patients have long-term survival (more than 20 years), including patient motivation (better followup), less vascular problems, less chronic decubitus and a higher percentage of lower motor neuron lesions. Patients with lower motor neuron lesions had the best bladder status associated with less upper tract deterioration.
A 21-year-old blond, white woman was evaluated for recurrent episodes of significant painless gross hematuria. She was found to have sickle cell trait, and hematologic evaluation made through four generations isolated the trait to the paternal side.
A papillary renal cell carcinoma developed in this patient in the same position that six years previously had undergone unroofing of a benign cyst. The discussion includes a brief review of the relationship between renal cyst and carcinoma.
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External urethral sphincterotomy on 129 paraplegics had little effect on erections. In the 101 patients with post-injury erections only 2 had cessation of erectile capacity. Subjectively, 16 per cent had partial loss and 13 per cent had an increase. The remaining 69 per cent had no change. When the data were correlated with level and completeness of injury, age, time since injury, time since sphincterotomy, postoperative delayed hemorrhage and effect on leg and bladder spasms, no conclusions could be drawn concerning the etiology of altered erections.
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A review is presented of 39 patients with spinal cord injury who were diverted by ureteroileostomy. Because of a significant complication rate and the fact that some normal renal units may deteriorate, the procedure is reserved for the patient with irreversible upper tract changes that fail to respond to more conservative management.
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