Microsurgery in urology
Wagenknecht, L.V.
Münchener Medizinische Wochenschrift 123(15): 613-615
1981
ISSN/ISBN: 0341-3098 PMID: 6785596 Document Number: 170650
Since a surgeon is limited more by his eyes than by his hands, there have been efforts over the last 3 decades to improve technology for microdissection and microsurgical reconstruction. 1st used by ophthalmologists and otologists, this technique became standard in neurosurgery, plastic surgery, and vascular surgery. It was 1st used in urology in 1965, for reconstruction of the vas deferens, and during the 1970s for vascular and urinary tract reconstructions. There has been extensive experimentation in animals, some of which has led to clinical use. Microsurgery improves and makes safer such operations as: reconstruction of abnormal vessels in donor organs during renal transplantations, establishment of arteriovenous shunts for hemodialysis, aneurysms, or stenoses of renal arteries, and dissection and anastomosis in treating penis and testicular trauma. Microsurgical implantation of the inferior epigastric artery into the corpora cavernosa has been used since 1973 with a 60% success rate for treating arteriosclerotic impotence. Renal trauma and preservative renal surgery are promising areas for Microsurgical application. Microsurgery simplifies and reduces complications of such procedures as: uretero-urethral anastomoses and uretero-sigmoidostomy, pyelourethral grafting and reconstruction of hypospadiac urethra in children, and reconstruction of the renal cavity following removal of kidney stones or tumors. Microsurgery is used in vasovasostomy following intentional or accidental occlusion of the vas deferens. Whereas earlier techniques produced a 64% permeability in this operation, microsurgery increases the success rate to 90%. The success rate of epididymovasostomies is 48% for bilateral anastomoses and 32% for unilateral anastomoses. In 16 men with ductal aplasia, a plastic prosthesis was mounted on the residual epididymis. Up to 100 million spermatozoa per specimen were found in the postoperative, percutaneous aspirations of the prosthesis contents. Microsurgery has a firm place in urology today. The anastomosis of fine tubular structures is greatly facilitated by the improved illumination and variable magnification offered by microsurgical techniques.