HF01-04 THE WAX-TIPPED CATHETER: DIAGNOSING URETERAL AND RENAL CALCULI PRIOR TO RADIOGRAPHY

Abstract

You have accessJournal of UrologyHistory of Urology Forum I (HF01)1 Sep 2021HF01-04 THE WAX-TIPPED CATHETER: DIAGNOSING URETERAL AND RENAL CALCULI PRIOR TO RADIOGRAPHY Sutchin R Patel, and Stephen Y Nakada Sutchin R PatelSutchin R Patel More articles by this author , and Stephen Y NakadaStephen Y Nakada More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001992.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Imagine a time without computed tomography, ultrasonography and x-ray. How would you diagnose an obstructing ureteral or renal stone? METHODS: We researched Howard Kelly and his seminal paper on the development of the wax-tipped catheter and searched the literature to evaluate the adoption of Kelly's technique by urologists in that era. RESULTS: In 1901, Howard Atwood Kelly (1858-1943) published "Scratch-Marks on the Wax-Tipped Catheter as a Means of Determining the Presence of Stone in the Kidney and in the Ureter." Kelly stated "There is no other means of ascertaining the presence of calculus in the urinary tract as direct as my method of passing a wax-tipped catheter up the ureter into the kidney." He described the preparation of the wax-tip (a mixture of dental wax and olive oil) and the technique of ureteral catheterization. A diagnosis was made if scratch-marks were found on the wax-tip. Kelly also stated that the stone sometimes created a "grating sensation as the catheter is withdrawn," that fragments of stone may become embedded in the wax tip and that as "the catheter passes a ureteral stone, or enters the renal pelvis there is often an immediate discharge of urine far in excess of possible secretion" (hydronephrotic drip). He further chronicles eleven cases where a dignosis was made using the wax-tipped catheter and then verified with open surgery.Ben Kirkendall (1882-1968) in 1915, further adapted Kelly's technique by using a loose fitting rubber tube which protected the wax-tipped catheter during its passage prior to ureteral cannulation.Hugh Hampton Young (1870-1945) in his text Practice of Urology (1926) wrote that "the diagnosis of renal calculus has been made a matter of great exactness by the introduction of the x-ray and the wax-tipped ureteral catheter." He further discussed three different methods of passing the wax-tipped catheter in detail.Abraham Ravich (1899-1984) in 1933 published his series of 758 ureteral calculi and stated that "the wax-tipped catheter was as important a diagnostic measure as x-ray and in uric acid stones was often the only means whereby a diagnosis could be made. The meticulous skill required to perform the wax-tipped catheter technique in order to prevent false positive results and the improvements in radiography eventually made the technique obsolete. CONCLUSIONS: Howard Kelly's wax-tipped catheter technique was the first reliable test to help diagnose ureteral and renal calculi prior to radiography. It would continue to have utility in diagnosing radiolucent stones until improvements in the quality of intravenous and retrograde pyelography. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e228-e228 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sutchin R Patel More articles by this author Stephen Y Nakada More articles by this author Expand All Advertisement Loading ...