US 3908637 A
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.
Description (OCR text may contain errors)
United States Patent Doroshow Sept. 30, 1975 RIGID URETHRAL INSTRUMENT  Inventor: Louls w. Doroshow 7902 Ivy Ln Pru mu-y branuner-Rmhard Gaudet 7 ASSISMH! Eazmuner-Rwk Opitz Baltimore, Md. -1..08
Anornqv. Agent, or lH'Hl-Fllt & Jacobson  Filed: Apr. 22, 1974 12H pp .1 57 ABSTRACT A rigid urethral instrument for introduction into the 128/2 3 mil/242i 128/341; bladder through the urethra, and for carrying out the A 123/349 R functions of a urethral sound and a urethral catheter. CL: A615 5/00; A51M 3/00; The major portion of the instrument is substantially A51M 29/00; A51M 25/00 linear. with the leading, or proximal end being curved Field sell'chm- 128/2 2 1 and terminating in a blunt dilating nose. A substan- 1 tially linear longitudinal bore extends through the 356, 345; 46/1 E, 6; 273/95 R. 95 C major portion of the instrument and serves to carry fluids between the distal and the proximal ends References Cled thereof. The longitudinal bore emerges from the prox- UNITED STATES PATENTS imal surface of the instrument in a region near the 2.541758 4/1951 Keeling 123/349 5 base of the curved portion. In one embodiment of the 3.751311 6/1956 m H 123 349 R instrument, the bore emerges from the distal surface 2.856.934 10/1958 Petillo 128/349 R near the most distal end thereof. In another embodi- 3.l38.l58 6/1964 Gordon et 11L... 128/348 ment, the bore emerges from the distal surface more 9 13/1968 l23/338 toward the proximal end,- uniting with an external tap for facilitating irrigation and medication of the bladmmcm der. In still another embodiment of the urethral instru- 3.811.448 5/l974 Morton 128/349 B provision is made at the most proximal end for FOREIGN PATENTS 0R APPLIATION the attachment of a standard dilating filiform.
476.004 7/1915 France 128/349 R 340.!28 9/1921 Germany 128/349 R 13 6 F'gures U.S. Patent Sept. 30,1975 Sheet 1 of 2 3,908,637
U.S. Patam Sept. 30,1975 Shem 2 of 98,637
RIGID URETI'IRAL INSTRUMENT 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 therbladder, 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 twostep 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. 7
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 1 /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 sur face 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 22 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 44 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 ofa 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 1% 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 l 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. 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 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 l0, 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 ofa 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. 5
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.
What is claimed is: Y
1. A surgical. instrument which combines the functions of a urethralsound 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.