A total of 59 patients with bladder outflow obstruction underwent the Madigan prostatectomy. The method, results and complications are described. For select patients with large benign adenomas without a median lobe or hematuria we believe the technique to be the operation of choice, particularly in younger patients. Advantages include absence of postoperative hematuria and clot retention, a decreased requirement for blood transfusions, a 16F postoperative catheter with early removal, avoidance of post-catheter stricture, a low rate of postoperative urinary infection, a short comfortable period of hospitalization and, in the long term (median followup 6 years), preservation of potency and antegrade ejaculation.
The purpose of this investigation is to show what parts of the rectum and pelvic colon are seen on sigmoidoscopy, the reason for the occasional inability to pass the instrument to its full length, and the areas where special care is necessary in looking for lesions. METHODPatients referred for routine barium enema examination from St. Mark's Hospital Out-Patient Department were selected for this study. The very young, the aged and infirm, women of childbearing age, and those with painful local lesions were excluded. Sixty-two patients were examined.The double-constrast enema technique (Young, 1966), was used for the radiological investigation of the colon and at the end of this examination a 25 x 1-3 cm or 30 x 1-9 cm Lloyd-Davies type of sigmoidoscope was inserted. An occasional difficulty was due to pooling of residual liquid barium suspension in the rectum. Elaborate attempts were not made to clear the bowel of barium and if after several attempts the sigmoidoscope could not be passed to its full length it was strapped to the buttocks with adhesive tape. The length of tube inserted was carefully read at the anal margin. If fulllength insertion was achieved the sigmoidoscope was similarly taped to the buttocks. Two films were then made, one with the patient supine, and one with the patient in the left lateral position, using an overcouch tube with a focus-film distance of 48 in. The instrument was then removed.In some cases a Michel clip was attached to the mucosa using a long forceps, and the sigmoidoscope was then withdrawn before the films were taken. This allows for safer movement of the patient. Figure 1 is the double-contrast radiograph of the rectosigmoid region. Figure 2 shows the sigmoidoscope inserted to 25 cm. Figure 3 shows a Michel clip attached to the mucosa after withdrawal of the sigmoidoscope.A plaster of Paris cast of a fist was made, with extended index finger, which measured 8-5 cm from tip to web, with a partial lead covering to increase density. By means of a wooden rod fixed in the base a digital rectal 'Present address: St. Michael's Hospital, Toronto 2, Canada examination was simulated, while postero-anterior and left lateral exposures were made as before.Figures 4 and 5 show the limits of digital examination. The technique and dangers of sigmoidoscopy are covered adequately in most standard works on the rectum and colon. A reminder of the anatomy of the rectum will assist in interpretating the radiographs. ANATOMY RECTUM The rectum ends distally by becoming continuous with the anal canal, which site is readily recognized by palpation of the ano-rectal ring, the ridge of pubo-rectalis muscle felt where the anorectal junction is angulated forward as it passes through the levator diaphragm. This point is about 3 cm from the anal margin. The rectum is about 12 cm long, following the curve of the sacrum. From above downward it also has three lateral bends, to the right, left, and right again, recognizable from the lumen as folds of the rectal wall, the valves of Houston. These are more con...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.