Fourteen cases of post-surgical granulomatous inflammation of the urin
ary tract were studied to investigate the possible deposition in the t
issues of metals derived from the diathermy instruments used. The gran
ulomas showed central necrosis, palisaded histiocytes and giant cells.
On electronmicroscopy both amorphous material and electron-dense part
icles were seen in the granulomas. The former appeared to be necrotic
tissue. The particles were metallic in nature. Energy dispersive analy
sis of X-rays showed the presence of tungsten, iron, copper, nickel, c
hromium, zinc and vanadium. Tungsten particles were always pure. Other
single particles contained two or more of the remaining elements, ind
icating the presence of alloy metals. Analysis of the diathermy instru
ments showed the cutting loops to be pure tungsten and the 'rollerball
s' to be of nickel silver containing copper, zinc, nickel, manganese a
nd iron. Both the loops and balls are supported on stainless steel wir
es containing iron, chromium, nickel, manganese, molybdenum, copper an
d vanadium. It is proposed that metallic fragments from the instrument
s were deposited in the tissues during the surgical procedures and eli
cited an immunological reaction with granuloma formation. Tungsten is
probably inert but nickel, chromium, copper and zinc are immunogenic.
Under certain circumstances both nickel and chromium may also be carci
nogenic.