Other

Advanced Urological Developments

Gary E Leach

Alexander Shkolnik

German G Borodulin

A cystoscope of the invention comprises a main portion (10) and a tubular sheath (12, 110) that carries on its distal end a balloon (22, 114, 214) inflatable from the outer side of the cystoscope for spreading apart the prostate lobes in the prostatic part of the urethra and thus improving conditions for observation and operation on the prostate. The invention also provides a cystoscope convertable into a resectoscope which consists of a sheath (12, 110) and an outer sleeve (112), slidingly guided over the sheath. On the outer side of its distal portion, the sliding outer sleeve (112) carries an inflatable balloon (114) which is connected to an air-feed tube (118) located inside the sheath. The outer sleeve is connected to an inner sleeve (116) which slides inside the sheath. The distal end face (110b) of the sheath is inclined at an acute angle to accommodate the inclined optical portion of the cystoscope, whereas the distal end face (116a) of the inner sleeve is arranged substantially at 90.degree. to the longitudinal direction of the instrument to define the resectoscopic end of the instrument. Thus, the instrument is inserted once and can be used both for observation and operation by shifting the inner sleeve forward or backward and replacing the optical system, thus converting the instrument into a resectoscope or a cystoscope. At the same, time, by supplying air into the balloon (114) via the air-feed tube (118), which also functions as a pusher for the moveable part of the instrument, it is possible to inflate the balloon (114) and thus to move the prostate lobes apart and to improve observation conditions in the operation site.

Method for improving observation conditions in urethra and a cystoscope

A method of laser-assisted prostatectomy which is based on the use of special laseroscope with continuous flow of the flushing and cooling liquid is provided. The method consists of inserting the above laseroscope into the patient's urethra with the laser fiber tip positioned at the prostate gland area, inserting a balloon catheter through the laseroscope to the urinary bladder neck, inflating the balloon of the catheter, initiating an inflow of washing and cooling liquid to the operating area, which is isolated from the urinary bladder by the balloon catheter, inserting a laser fiber into the laseroscope, firing the laser fiber and directing a laser beam laterally from the laser fiber onto the prostatic gland for directing the laser beam to the required area. The method is carried out by means of an apparatus comprising a tubular sheath (10) with three guide tubes, i.e., a guide tube (13) for an optical lens system (12), a second guide tube (14) for a laser fiber (16), and a third or auxiliary guide tube (18) for interchangeably inserting: a cleaning brush (19), which may rotate and reciprocate in the guide tube (18) for cleaning the operating tip of the laser fiber (16); an ultrasonic probe (40) for measuring the degree and depth of ablation of the prostatic tissue; and a balloon catheter (42) for the occlusion of the bladder neck. Spaces (15a) and (15b) between the inner surface of the sheath (10) and the outer surfaces of the guide tubes form mutually isolated channels for the continuous supply and removal of the flushing and cooling liquid.

Method of laser-assisted prostatectomy and apparatus for carrying out

A urological instrument combining in itself a function of a prostate retractor and an instrument for the insertion of a suprapubic catheter. The instrument has a curved tubular body (10) inserted into which is a flexible metallic tubular catheter (32). The catheter (32) is moveable from a feed mechanism (24) and is pivotally connected to a pair of foldable jaws (40 and 42) located on the distal end of the instrument. When the catheter is shifted towards the proximal end of the instrument, the jaws (40 and 42) are opened and when the catheter is shifted towards the distal end, the jaws are folded and are used for the attachment of a bullet-like perforating cup (56). The catheter (32) has a leader (64). For use as an instrument for the insertion of a suprapubic catheter (104), the instrument is introduced into the patient's urinary bladder (14) and then is moved forward for perforating the anterior abdominal wall by pushing a leader (64) and then using this leader as a guide for directing the bullet-like perforating cup which expands the perforation channel. The instrument is then used as a conventional instrument for the insertion of a suprapubic catheter (104). In case the instrument is used as a retractor, the jaws are opened and form a lever for pulling the bladder neck and the prostate outward to a position more accesable for the urologist who performs an operation.

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Rowland Heights, CA, United States of America

Gary E Leach