Biomedical subjects
Publications and source records attributed to R Witherington.
A prolapsed ureterocele occurs more frequently in female subjects than in male subjects. At least 64 cases in female patients have been reported and an additional case in a 2-year-old girl is reported herein. Only 3 cases have been reported in male subjects. A method for management of a non-reducible ureterocele in female patients is outlined and discussed briefly.
Explore the source record for details and available documents.
An experimental study was performed comparing 6-0 polypropylene and 6-0 polyglycolic acid sutures in vasovasostomy. An indwelling entirely intraluminal splint of PE-10 tubing was used which was surgically removed three weeks postoperatively. Three months after vasovasostomy patency was determined by vasography. Eighty-five per cent patency was achieved with polyglycolic acid compared with 58 per cent patency when polypropylene was used.
At our institution, 100 patients had ileal conduit diversion using the Pyrah technic between 1959 and 1975. The results of this technic compare favorably with those of other ileal conduit diversions, and it has the advantage of being somewhat shorter than the standard Bricker procedure. Sixty-seven were done because of benign lesions of the urinary tract and 33 were done as part of the planned treatment of various malignant conditions. We did 56 diversions in patients with neurogenic bladder dysfunction. There were 67 early and 69 late complications, and the complication rate was much higher in patients having preoperative irradiation. The most common complications were wound infections, pyelonephritis, ureteroileal anastomotic leaks or stricture, and stomal stenosis. The upper urinary tracts showed signs of progressive deterioration after diversion in 19% of patients. The operative mortality was 6%. The mortality was four times greater in the group with malignant conditions.
Experimental vasovasostomy in dogs using polyethylene tubing for splints and comparing polyglycolic acid to polypropylene sutures demonstrates the following: Polyglycolic acid sutures result in a higher vasovasostomy patency rate. Grossly and microscopically, polyglycolic acid sutures are associated with less vasal and perivasal fibrosis. Postoperative use of very small polyethylene tubing for splints appears feasible. Leaving splints entirely intraluminally at the time of surgery may be advantageous. It would necessitate vasotomy for removal of the splint postoperatively, but this is easily accomplished and not associated with increased morbidity. A transscrotal approach is associated with a much higher vasal patency rate than is an inguinal approach.
Cryopreservation of semen has a place in reproductive medicine. It is done best using liquid nitrogen as the refrigerant and the pre-freeze semen should be of good quality. High quality spermatozoa survive the freezing-thawing process and ordinarily result in good babies. Abnormal sperm generally do not survive the freezing-thawing process, which, consequently, results in a more viable union and outcome from the germ cells. Cryopreservation of semen can be used to preserve semen before medical or surgical sterilization, to augment the sperm count in patients with certain types of oligospermia and to manage the childless couple by donor semen artificial insemination in those instances in which the husband is infertile. Cryopreserved semen produces babies and perhaps thousands of humans have been the result of conception that resulted from cryopreserved spermatozoa.
Two patients, 1 adult and 1 infant, with complete duplication of the penis are described. The adult had a single bladder, a bifid scrotum, a low abdominal wall hernia, separation of the symphysis pubis, bilateral inguinal hernias, rectal prolapse, bilateral vesicoureteral reflux and bilateral staghorn calculi. The infant had duplication of the bladder, hypoplasia of the left kidney, lumbosacral anomalies, a hypoplastic left lower extremity, an imperforate anus, a infraumbilical wall hernia and separation of the symphysis pubis. A survey of the anomalies accompanying the 2 main types of diphallus (shaft and glans, and glans alone)showed that there was a preponderance of anomalies of posterior structures such as colon, bladder and spine in the shaft and glans diphallus, and a higher incidence of isolated exstrophy of the bladder in diphallus of the glans alone. The embryogenic implications of these findings are discussed.
A review of 226 transvesical prostatic adenomectomies performed by a modification of Hryntschak's technique over a 13-year span is presented. The technique incorporates closure of the vesical neck with transverse sutures of 2-0 plain catgut around a plastic Foley catheter and primary closure of the cystotomy following routine adenoma enucleation. Hemostatic suturing of the posterior vesical neck before placement of the transverse vesical neck sutures is routinely omitted. The results have been uniformly good with low incidence of mortality and morbidity. The average operative blood loss was 761 ml and postoperative bleeding was minimal. This technique is safe, simple and requires an acceptable operating time.
One hundred patients underwent ileal loop diversion using the Pyrah technique between 1959 and 1975. Sixty-seven were performed because of benign urinary tract lesions and 33 were performed as part of planned treatment of various malignant conditions. Neurogenic bladder dysfunction accounted for 56 of these diversions. There were 67 early and 69 late complications. Patients having preoperative irradiation therapy had a much higher incidence of complications. An alarming 19 per cent demonstrated progressive deterioration of the upper tracts following diversion. It is noteworthy that this rate of upper tract deterioration compares favorably with that reported in several other series. Early mortality was 6 per cent, and death occurred four times more often in patients with malignant conditions.
An increased incidence of neoplasia at the site of ureterosigmoidostomy must be considered in patients being evaluated for or who have undergone this procedure. A case of mucinous adenocarcinoma 24 years following bilateral ureterosigmoidostomy is reported. This patient had bilateral hydroureteronephrosis, which led to left nephroureterectomy and right cutaneous ureterostomy. Mucinous adenocarcinoma was diagnosed only after the edematous, protruding and inflamed cutaneous ureterostomy stoma was biopsied. To our knowledge this is the first reported case of transfer of such a malignancy to the skin at the time of cutaneous ureterostomy. We recommend that ureterosigmoidostomy be performed only in patients with a limited life expectancy who agree to long-term followup. This followup should be frequent, complete and continue for the remainder of the patient's life. We consider the tendency for development of neoplasia at the ureterosigmoid anastomosis to be a relative contraindication to ureterosigmoidostomy. However, with proper patient selection and followup, ureterosigmoidostomy is still a remarkably satisfactory method of urinary diversion.
Explore the source record for details and available documents.
Two cases of idiopathic retroperitoneal fibrosis are discribed. In both cases intrinsic involvement of the ureteral muscularis was found, which is in contradistinction to the classical description of ureteral encasement or compression by the process without actual invasion. Surgical procedures, in addition to ureterolysis, may be required.
Rhabdomyosarcoma of the spermatic cord is a rare, highly malignant lesion, for which the optimum treatment has yet to be ascertained. Results of treatment of 3 patients are presented, making the total reported experiences 53 cases. Two of our 3 patients are alive. One survivor underwent retroperitoneal lymphadenectomy and the other received radical orchiectomy only. The third patient had metastasis at the time of diagnosis and subsequently died. Because of a paucity of knowledge concerning the disease, its propensity for youthful patients and its highly malignant characteristics, all treatment modalities must be considered and tailored to the needs of the individual patient.
A preliminary study upon seven dogs comparing vasovasostomy using polypropylene suture to vasovasostomy using polyglycolic acid suture was carried out. Five of the seven vasa anastomosed with polyglycolic acid sutures were patent wherease none of the seven vasa anastomosed with polypropylene sutures were patent. There appeared to be less vasal inflammatory reaction where vasovasostomy had been accomplished with polyglycolic acid. This study indicates that further investigation comparing these and other suture materials in vasovasostomy is justified. It also suggests that improved results in vasovasostomy might be obtained by the use of polyglycolic acid suture.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.