U.S. patent number 3,908,637 [Application Number 05/463,190] was granted by the patent office on 1975-09-30 for rigid urethral instrument.
Invention is credited to Louis W. Doroshow.
United States Patent |
3,908,637 |
Doroshow |
September 30, 1975 |
Rigid urethral instrument
Abstract
A rigid urethral instrument for introduction into the bladder
through the urethra, and for carrying out the functions of a
urethral sound and a urethral catheter. The major portion of the
instrument is substantially linear, with the leading, or proximal
end being curved and terminating in a blunt dilating nose. A
substantially linear longitudinal bore extends through the major
portion of the instrument and serves to carry fluids between the
distal and the proximal ends thereof. The longitudinal bore emerges
from the proximal surface of the instrument in a region near the
base of the curved portion. In one embodiment of the instrument,
the bore emerges from the distal surface near the most distal end
thereof. In another embodiment, the bore emerges from the distal
surface more toward the proximal end, uniting with an external tap
for facilitating irrigation and medication of the bladder. In still
another embodiment of the urethral instrument, provision is made at
the most proximal end for the attachment of a standard dilating
filiform.
Inventors: |
Doroshow; Louis W. (Baltimore,
MD) |
Family
ID: |
23839208 |
Appl.
No.: |
05/463,190 |
Filed: |
April 22, 1974 |
Current U.S.
Class: |
600/573; 604/104;
606/191; 600/550 |
Current CPC
Class: |
A61B
1/12 (20130101); A61M 25/0069 (20130101); A61M
29/02 (20130101); A61M 25/0041 (20130101); A61B
1/307 (20130101) |
Current International
Class: |
A61M
25/00 (20060101); A61M 29/00 (20060101); A61B
1/12 (20060101); A61B 1/307 (20060101); A61B
005/00 (); A61M 003/00 (); A61M 029/00 (); A61M
025/00 () |
Field of
Search: |
;128/2F,2M,328,341-342,343,348-350,DIG.9,DIG.16,20,347,356,345
;46/1E,6 ;273/95R,95C |
References Cited
[Referenced By]
U.S. Patent Documents
Foreign Patent Documents
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|
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|
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476,004 |
|
Jul 1915 |
|
FR |
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340,128 |
|
Sep 1921 |
|
DD |
|
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Opitz; Rick
Attorney, Agent or Firm: Fleit & Jacobson
Claims
What is claimed is:
1. A surgical instrument which combines the functions of a urethral
sound and a urethral catheter, the instrument comprising: an
elongated cylindrical substantially linear main body portion; a
curved dilating nose portion continuous with and extending from one
end of said main body portion, said dilating nose portion and said
main body portion being rigid and sharing a common plane; a handle
portion continuous with and extending from the opposite end of said
main body portion; a substantially linear passageway through said
main body portion and extending substantially from said dilating
nose portion to said handle portion; wherein one end of said
passageway extends through the base of the dilating nose portion
and emerges from said instrument on the convex side of said
dilating nose portion, and wherein the other end emerges in the
region of said handle portion.
2. The instrument of claim 1, wherein said handle portion is
flat.
3. The instrument of claim 2, wherein the flat handle portion lies
in a plane which is perpendicular to said common plane.
4. The instrument of claim 1, wherein said passageway is
substantially coaxial with said cylindrical main body portion.
5. The instrument of claim 1, wherein said dilating nose portion is
tapered from its juncture with said main body portion, and
terminates in a blunt dilating nose.
6. The instrument of claim 1, and further comprising a flexible
filiform continuous with and extending from the end of said
dilating nose portion remote from said main body portion.
7. The instrument of claim 1, and further comprising tap means in
the region of said handle portion for establishing fluid
communication out of said instrument from said passageway.
8. The instrument of claim 7, wherein said tap means comprises a
nipple threaded into said main body portion; said nipple having a
passageway therethrough which establishes said fluid
communication.
9. The instrument of claim 7, and further comprising injection
means for introducing a fluid into said tap means, through said
passageway, and out of said instrument at the juncture of said main
body portion and said dilating nose portion.
10. The instrument of claim 9, wherein said injection means is a
syringe.
11. The instrument of claim 10, and further comprising: flexible
tubing for developing a fluid path between said syringe and said
tap means.
12. The instrument of claim 1, wherein said passageway terminates
in a blind end in the region of said handle portion; and further
comprising tap means for establishing fluid communication out of
said instrument from said passageway.
13. A combined urethral sound and urethral catheter, comprising: an
elongated right cylindrical main body portion; a smooth nose
portion continuous with and extending from one end of said main
body portion, said nose portion being curved and mating with said
main body portion at a base portion, said nose portion and said
main body portion each being rigid; a handle portion continuous
with and extending from the opposite end of said main body portion;
and a passageway extending through said main body portion, one end
of said passageway extending through the base of said nose portion
and emerging from said instrument on the convex side of said nose
portion and the other end of said passageway emerging from said
instrument in the region of said handle portion.
Description
BACKGROUND OF THE INVENTION
The present invention relates to a surgical instrument which finds
use to aid patients, both male and female, suffering from
strictures or stenoses of the urethral passage. These physical
obstructions restrict the free flow of urine from the bladder,
often resulting from tissue inflammation, the presence of foreign
bodies, or iatrogenic reactions. To relieve the frequently
uncomfortable obstructions, it is common practice to dilate the
urethral passage with a rigid instrument known as a sound. In the
same procedure, the bladder is often relieved of its urine content,
irrigated with a flushing liquid, or medicated by way of a flexible
urethral catheter.
The above procedure of dilating the urethra is most commonly
carried out with a solid urethral sound, often equipped with a
filiform dilating tip. If the bladder is to be drained, irrigated
or medicated, the usual practice is to remove the sound and to pass
a flexible catheter through the urethra and into the bladder. Once
the proximal end of the catheter is in the bladder, the bladder can
be drained, irrigated or medicated.
There are several problems which may be encountered by practicing
the two-step procedure described in the preceding paragraphs. For
one, the urethral obstruction occasionally blocks the flexible
catheter even after prior dilation with a sound. In these cases,
further dilation may be appropriate.
Another drawback is directly related to the common practice of
employing a two-step procedure. As such, the risks of trauma and
the possibility of introducing impurities into the urinary tract
are doubled.
There are today, urethral instruments which eliminate the necessity
for a two-step procedure when draining, irrigating or medicating
the bladder. Instruments have been developed which combine the
functions of a sound and a catheter, each taking the form of a
hollow rigid sound having a curved dilating nose at the most
proximal end thereof. The hollows of these known instruments all
open at the proximal ends well within the curved regions thereof.
While such instruments have successfully eliminated the major
drawbacks related to the two-step procedure, catheter blockage and
bladder medication, there are still substantial drawbacks related
to bladder irrigation and drainage which remain to be overcome.
Because the proximal opening of the passage in the instrument is
positioned within the region of curvature, the opening usually
remains high in the bladder during the surgical procedure with the
patient in the supine position. Therefore, since the bladder drains
only to the level of the opening at the proximal end of the
instrument, a substantial amount of urine remains in the bladder.
If the bladder is only half drained, it will again be filled to
capacity in approximately 11/2 to 2 hours. Therefore, the time
during which the urinary tract could recover from the operative
procedure is shortened by a factor of two from the 3 to 4 hour
recovery time which would result if the bladder were completely
emptied. This drawback is important both when draining and
irrigating the bladder.
Also known to the prior art is a linear hollowed urethral
instrument of the type developed specifically for feminine use. It
should here be noted that the present invention relates to a
versitile curved instrument useful for procedures involving both
the female and the male.
It is broadly an object of the present invention to provide a
combined urethral sound and catheter which eliminates each of the
drawbacks noted above.
A more specific object of the present invention is to provide a
combined urethral sound and catheter for use in procedures
involving both males and females, for penetrating strictures and
stenoses in the urethra, and for effectively draining, irrigating
or medicating the bladder.
A further object of the present invention is to provide a combined
urethral sound and catheter which, after introduction into the
bladder through the urethra, is capable of effecting a
substantially complete drainage of liquid from the bladder.
Another object of the present invention is to provide a combined
urethral sound and catheter through which medication and irrigating
fluids can be introduced to the bladder in a sterile fashion, and
through which a sterile urine sample may be extracted from the
bladder.
These and other objects of the present invention, as well as many
of the attendant advantages thereof, will become more readily
apparent when reference is made to the following description taken
in conjunction with the accompanying drawings.
SUMMARY OF THE INVENTION
The present invention relates to a rigid urethral instrument which
is substantially linear over the major portion of its length and
terminates in a curved dilating nose portion for leading the way
through the urethra and into the bladder. A substantially linear
hollow passageway leads from the distal to the proximal end of the
instrument, and serves to carry liquids therethrough. The proximal
end of the passageway opens at the surface of the instrument at the
base of the curved dilating nose.
In one embodiment, the distal end of the passageway emerges in the
region of a flattened handle. In another embodiment, the distal end
of the passageway communicates with an external tap adapted to
associate, for example, with a syringe. In this embodiment, the
instrument is equipped to accomplish the extraction of a sterile
urine specimen, the application of a medication, or irrigation of
the bladder. The inventive instrument may also be equipped with a
standard flexible filiform tip.
The important feature of the present invention is that the proximal
end of the passageway emerges at the base of the curved dilating
nose, thereby lying deep in the bladder when in use while the
patient is in the supine position. In this manner, drainage of the
bladder is substantially complete, and the drawbacks of all known
surgical instruments are substantially eliminated.
In addition to the above, all embodiments of the present invention
have the advantage of manufacturing simplicity. The fluid-carrying
passageway through the instrument is substantially linear, and
hence manufacture is facilitated, whether through casting or
drilling. Furthermore, because linear over a major portion of its
length, the instrument may conveniently be manufactured in several
sections.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is a longitudinal cross section taken through the urethral
instrument of the present invention;
FIG. 2 is a cross section of the inventive instrument taken along
line 2--2 of FIG. 1;
FIG. 3 is a rear plan view of the inventive instrument taken along
the sight line 3--3 of FIG. 2;
FIG. 4 is a front plan view of the inventive instrument taken along
the sight line 4--4 of FIG. 1;
FIG. 5 is an illustration of the inventive urethral instrument when
positioned within the bladder; and
FIG. 6 is a view similar to FIG. 1, illustrating another embodiment
of the inventive urethral instrument.
DETAILED DESCRIPTION OF THE DRAWINGS
With reference first to FIGS. 1 through 4, one embodiment of the
present invention will be described. The inventive urethral
instrument which combines the functions of a urethral sound and a
urethral catheter is shown generally at 10. The instrument 10 is
rigid, constructed, for example, of drilled or casted stainless
steel. Throughout the major portion of its length, the body of
instrument 10 is substantially linear as shown at 12. At the
leading or proximal region of the linear body 12 is a curved
dilating nose portion 14. A flattened handle 16 is located at the
rearward or distal region of body 12.
The general outline of the inventive instrument is well known,
following that of a conventional urethral sound. As illustrated,
with the curved dilating nose portion 14, the instrument 10 is
specifically adapted for insertion into the bladder of a male
through the curved 8 to 9 inch urethra as measured from the urinary
meatus to the neck of the bladder. It should be understood,
however, that the same instrument is equally useful for
introduction into the female bladder through the substantially
linear 11/2 inch urethra. The rear handle portion 16 of the
instrument 10 is also of conventional design. While not critical to
the present invention, the handle 16 is illustrated as being
flattened, for with this known configuration, the tactile
sensitivity of the physician is increased.
As clearly illustrated in FIG. 1, a substantially linear passageway
18 extends through the linear body portion 12 of the instrument 10,
with the distal end emerging from the instrument at 32 in the
region of the handle portion 16. The proximal end of the passageway
18 emerges from the surface of the instrument at 26 in the region
of the base of the dilating nose 14. The instrument shown in FIG. 1
is of three-piece construction, with the linear body portion 12
mating with the nose portion 14 and the handle portion 16 by way of
threaded sections 20. The three-piece construction is to facilitate
manufacture by drilling, and is optional.
With reference now to FIG. 5, the insertion and operation of the
inventive urethral instrument 10 will be described. When fully
inserted, the proximal nose end 14 of the instrument 10 resides
within the bladder 22, with the linear body portion 12 lying within
the urethra 24. The opening 26 of the passageway 18 lies just
inside the neck 28 of the bladder 22. The introduction of the
inventive urethral instrument 10 into the bladder 22 of the
patient, whether male or female, is accomplished in a manner
well-known to physicians.
FIG. 5 illustrates the patient lying in the supine position, as is
conventional during this particular operative procedure. For
purposes of orientation, the chest and buttocks are indicated by
arrows. The instrument 10 is delicately fed through the urethra 24
until the dilating nose 14 lies within the confines of the bladder
22. When the specially designed instrument is so positioned, the
opening 26 of passageway 18 lies just inside the neck 28 if the
bladder 22. The numeral 30 indicates the urine level in a partially
filled bladder. With the inventive instrument 10, urine is drained
from the bladder 22 by way of opening 26, passageway 18, and the
opening 32 at the handle end 16. As should be evident from FIG. 5,
the position of opening 26 ensures that urine is substantially
completely drained from the bladder 22, taking a final level such
as that illustrated in phantom at 34. When using the prior art
instruments having the drainage passageway opening in the region of
the curved nose (where indicated at 36), the bladder can be only
approximately half emptied of its urine content.
The surgical instrument illustrated in FIGS. 1 through 5 finds use
in dilating a urethra having a stricture or stenosis and in
simultaneously draining the bladder of its urine content. However,
it is often desirable to medicate the bladder, to flush or irrigate
the bladder, or to extract a sterile urine specimen. In this
regard, attention is directed to FIG. 6, in which another
embodiment of the present invention is illustrated.
In FIG. 6, another embodiment of the inventive urethral instrument
is shown generally at 10'. Like that illustrated in FIG. 1, the
instrument 10' of FIG. 6 has a substantially linear body portion
12' and a curved dilating nose portion 14'. The passageway 18' in
the instrument of FIG. 6, however, does not emerge from the
instrument at the extreme distal end. Rather, the passageway 18'
extends from an opening 26 at the base of the curved nose 14',
through the linear body portion 12' and terminates at blind end 38
located proximally of the distal handle portion 16'.
A nipple 40 is threaded into a tapped bore in the instrument at a
position substantially between the linear body portion 12' and the
flat handle portion 16'. A gasket 42 surrounds the base of the
nipple 40 and abuts the nut 44 integral with the nipple to seal
against fluid leakage. As illustrated in FIG. 6, a tube 46 as of
rubber, is fitted over the nipple 40, and the nose of a syringe 48
is fitted on the opposite end of the tube 46. Syringe 48, as
positioned, can be used for the introduction of medication into the
bladder through tube 46, nipple 40, passageway 18' and out of
opening 26, for irrigation with a liquid, or for the extraction of
a urine specimen. FIG. 6 also illustrates the inventive surgical
instrument 10' fitted with a bougie, or filiform 50. The filiform
50 is threadably engaged, at 52, on the forwardmost extremity of
the nose portion 14'.
The introduction of the instrument 10' into the bladder is
identical with the introduction of instrument 10. In operation,
instrument 10' can be used for bladder drainage (without tube 46
and syringe 48), but is especially designed for bladder medication,
sampling and irrigation. Like instrument 10 illustrated in FIG. 1,
instrument 10' of FIG. 6 can be used for both males and
females.
In the foregoing passages, specific embodiments of the present
invention have been described. It should be clearly understood that
these specific embodiments have been described for purposes of
illustration only, without any intention of limiting the scope of
the present invention. Rather, it is the intention that the present
invention not be limited by the above, but be limited only as
defined in the appended claims.
* * * * *