Urology

UROLOGY. The branch of medicine—chiefly surgical—that deals with diseases of the genito-urinary organs. Recent progress in urology has been due largely to improvements in the cysto scope, advances in radiology, use of diathermy and close co-opera tion between urologists, bacteriologists, and biochemists. Endo vesical instruments are now available from the simplest cysto scope, consisting of a telescope within an irrigating sheath, to complicated instruments with which lesions can be treated sur gically under direct vision instead of by an open operation.

Similarly, advances in radiology have led to the detection of calculi hitherto regarded as transparent to the rays, and to stereo scopic radiograms indispensable for locating a suspicious shadow in the neighbourhood of the kidney or ureter. Pyelography also gives information concerning the size and shape of the renal pelvis and calices. A skiagram is taken after a fluid opaque to the X-rays (e.g., sodium iodide or lipiodol) has been introduced into the renal pelvis by means of a ureteric catheter. It is of great value in diagnosing early dilation of the kidney, silent hydronephrosis, polycystic kidney, malformation of the pelvis and renal tumours encroaching on the pelvis ; in localising shadows in the renal area such as calcified mesenteric glands and gall stones, and in differ entiating between abdominal and renal tumours. By similar means, silhouettes of the bladder or male urethra can be obtained, though in the latter instance they are not indispensable, for the canal can be examined easily and thoroughly with a urethroscope.

Perirenal inflation with CO, was introduced by Carelli of Buenos Aires and in radiographs shows clearly alterations in shape, size and density, therefore being useful in such conditions as early hydronephrosis, polycystic kidneys, tuberculosis, tumours and stones not dense enough to show by ordinary radiography; but its greatest value lies in giving a clear and distinct radiogram of the suprarenal capsule.

Diathermy.

Diathermy (see ELECTROTHERAPY) acts by vir tue of the heat generated in the tissues by the resistance they offer to the passage of an electric current. For this purpose a very strong current must be used, deprived of its stimulating and electrolytic properties by alternations of not less than 500,00o per second.

The only sensation produced by a current of such high fre quency is one of heat ranging, according to the strength of the current, from a pleasing warmth to a temperature high enough to char the tissues for a distance of about i cm. from the electrode.

All degrees of diathermy are used for diseases of the genitourinary system, the lower temperatures for testicular neuralgia and epididymo-orchitis, chronic urethritis and prostatitis, and benign enlargement of the prostate when a radical operation is inadvisable. Destructive diathermy is now the method of choice in the treat ment of certain forms of papilloma of the bladder and urethra, and in the median bar type of prostatic obstruction. It has been used with moderate success for carcinoma of the pros tate.

Use of Radium.

Radium (q.v.) has been used extensively for carcinoma of the prostate and bladder. It is applied in the form of needles and emanation tubes or seeds implanted directly into the growth, but has not yet emerged from the experimental stage. Caution is required in its use, for large doses produce great irrita tion and may be followed by excessive infiltrations of the bladder neck. Again, emanation tubes placed too close to the pouch of Douglas have caused peritonitis and death. In view of these dis advantages and the discouraging results they have encountered many urologists are now averse to using it at all.

Urinary Antiseptics.

Both mercurochrome and hexyl-resor cinol are powerful antiseptics, and though not "ideal" are valuable additions to the comparatively few powerful bactericides which can be administered with safety. Mercurochrome can be used either locally or intravenously. In cases of chronic cystitis, usually due to the colon bacillus, instillation of a watery solution (0.2 1.o%) sometimes has a remarkable effect. In pyogenic coccal infections the results are not so striking. In pyelitis, irrigation with mercurochrome is not so irritating as with silver nitrate. Instillations appear to be particularly valuable for chronic pos terior urethritis, especially when complicated by prostatitis and vesiculitis. When given intravenously in doses of from i to 5 mg. per kg. of body weight results have been most encouraging, especially in acute coccal and bacillary infections of the genito urinary tract associated with pyrexia. Chronic afebrile colon bacilluria, on the other hand, does not always respond so readily to this treatment. In rare cases, pronounced febrile and gastro intestinal reactions follow the injection but these usually subside in 24 hours. The danger to the kidneys of such a powerful mer curial compound must never be overlooked, but Young (Balti more) considers it may be used intravenously without fear of injury.