Non-operative procedures in urology

Abstract

T HE remarkabIe stride which has been made in the deveIopment of cystoscopic technique within the last two decades, the better understanding of underlying pathoIogy made possibIe by the introduction of urography, have tended to conservatism in the management of uroIogica1 conditions to a degree never known before. CauIk in his presidentia1 address before the American UroIogicaI Association Iaid emphasis on the fact that “in spite of surgica1 preparedness and surgica1 efficiency, the striking tendency of uroIogy today is conservatism. Science has reduced uroIogica1 surgery in the Iast quarter of a century to a striking degree in spite of the fact that it has given faciIities for its advancement . . . Many of the operations have been either restricted or erased from our surgica1 caIendar.” However true the above may be, a word of warning is in order against overinduIgence in conservative manipulations in various obstructed, infected or neopIastic Iesions of the urinary tract. A Iine must be drawn sharpIy between what constitutes an operative Iesion or a condition where cystoscopie measures have a reasonabIe chance to succeed. This entaiIs a carefu1 study of the case and a correct diagnosis. Too much temporizing with true surgica1 conditions is the one great danger so commonIy seen and which must be avoided. I shaI1 endeavor brieffy to enumerate the various conditions in the urinary tract which may be corrected by the empIoyment of minor surgica1 procedures in as much as they entail cystoscopic manipuIation, touching upon indications and, as much as the space wiI1 permit, on technique. I. Urethral stones frequentIy become Iodged either in the anterior or posterior YORK