26
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Jordan GH, Winslow BH, Devine CJ. Intraoperative consultation for the urethra. Urol Clin North Am 1985; 12:447-52. [PMID: 4024381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The urologist is frequently summoned to the operating room to assist with urethral catheterization. This article presents the authors' method and techniques for dealing with the "impassible urethra." Oftentimes the patient has been traumatized. A sequential plan is presented that allows for maximal evaluation of the entire urinary tract along with eventual urethral catheterization. In the case of the disrupted urethra, diversion must be accomplished. The authors have found that the placement of a urethral catheter along with division of intact puboprostatic ligaments in the stable patient frequently limits the eventual morbidity of the trauma.
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Abstract
Penile curvatures are common. They are caused by tethering inelastic tissues that can be from the skin externally, from the congenital fibrous tissue of hypospadias and epispadias, and from inelastic tunica albuginea as in fractures, trauma, or Peyronie's disease. At the present time, with sexual organs exposed in photographs, human sexuality talked about with more freedom, and sexual experiences more open, a great deal of mental stress and anxiety can be produced by penile curvatures. Adjunct to this are impotency and other sexual problems. Surgical treatment is generally curative with grafts, flaps, excision of tunica albuginea, or repositioning and coaptation of the corporal bodies. Also, the use of a sex therapist can offer additional aid to the physician and realistic acceptance by the patient. More attention should be given to the patient with this problem. It is not well recognized by most physicians, and therefore, patients may suffer needlessly in silence without adequate help.
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Abstract
Of 62 hospitalized patients with Peyronie's disease 18 (29 per cent) had abnormal nocturnal penile tumescence studies that were characterized as indicating organic impotence. However, the majority of these patients had some underlying disease or factor other than the plaque itself to explain the altered nocturnal penile tumescence. In only 5 per cent of these patients could the abnormal nocturnal penile tumescence be attributable to the plaque itself. Primary excision of the plaque and dermal grafting improved erectile function in all except a minority of patients who required insertion of a penile prosthesis to alleviate continued erectile impotence. For this reason we do not recommend insertion of a penile prosthesis during plaque excision. The plaque of Peyronie's disease does not appear to impede vascular flow distal to the plaque. However, previous excision may result in altered hemodynamics that can result in erectile impotence.
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Jones WJ, Horton CE, Stecker JF, Devine CJ. The treatment of psychogenic impotence after dermal graft repair for Peyronie's disease. J Urol 1984; 131:286-8. [PMID: 6366251 DOI: 10.1016/s0022-5347(17)50348-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
We studied 20 men who failed to resume coitus after a dermal graft repair for Peyronie's disease. Psychogenic causes were found in 15 men, 10 of whom were treated locally by the sex counselors who interviewed all the couples. Psychogenic dysfunction was related to waiting for healing or for a specified period, then approaching first coitus either with idealized expectations or as if it were a test. Of the 10 treated men 3 also had marital conflict and 5 others had lack of a partner or poor motivation, including 1 who also suffered some instability of erection possibly of structural cause. In most of the treated men relief of anxiety and conflict proved effective, and coitus was restored. We are now evaluating possible improved results in new operative candidates through preoperative and postoperative counseling, which emphasizes a less pressured approach to coitus postoperatively.
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31
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Abstract
Capillary hemangiomas of the urethra are rare benign tumors that may behave in a persistently recurrent manner. Radical extirpative surgery may be necessary to cure the patient. We describe a new 2-stage technique for replacing long segments of urethra.
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32
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Brezinski AE, Devine PC, Devine CJ, Horton CE, Ladaga LE. Full thickness urethral patch grafts in male rats: an experimental model. Urology 1982; 20:611-3. [PMID: 7179628 DOI: 10.1016/0090-4295(82)90311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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33
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Abstract
The types of fracture of the bony pelvis are categorized, and a system for diagnosis and treatment is recommended which should prevent many strictures and make those which do develop, easier to repair secondarily. This system of treatment should reduce trauma to the nerves and blood vessels.
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34
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Leffell MS, Devine CJ, Horton CE, Somers KD, Dawson D, Vande Berg JS, Bluemink GG, Wright GI. Non-association of Peyronie's disease with HLA B7 cross-reactive antigens. J Urol 1982; 127:1223-4. [PMID: 6979636 DOI: 10.1016/s0022-5347(17)54302-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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35
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Somers KD, Dawson DM, Wright GL, Leffell MS, Rowe MJ, Bluemink GG, Vande Berg JS, Gleischman SH, Devine CJ, Horton CE. Cell culture of Peyronie's disease plaque and normal penile tissue. J Urol 1982; 127:585-8. [PMID: 7038152 DOI: 10.1016/s0022-5347(17)53917-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Cell cultures derived from Peyronie's disease plaque and normal penile tissue were characterized morphologically and examined by immunofluorescence for actin cable formation, and their growth properties were compared. Relative to normal penile cell cultures which grew as contact inhibited, poorly refractile fibroblast-like cells, plaque derived cell cultures consisted of round and spindle shaped cells that were more refractile and exhibited random crisscross growth patterns. Scanning electron microscopy of plaque derived cell cultures revealed changes in cell surface topography characterized by the appearance of surface membrane blebs amd microvilli. Transmission electron microscopy demonstrated cells containing organized cytoplasmic microfilament bundles and nuclear indentations which resembled myofibroblasts. Such alterations were less extensive or absent in normal penile cell cultures. The amount and extent of actin cable formation was increased in plaque derived compared to normal penile cell cultures. Plaque derived cells also exhibited differences in growth properties and grew to higher saturation densities than their normal counterparts. These results demonstrate that cells derived from Peyronie's disease plaque can be grown in vitro and that these cells are morphologically altered and have an enhanced proliferative capacity. The availability of these cell cultures will permit studies directed at understanding the etiology and pathogenesis of Peyronie's disease.
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36
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Vande Berg JS, Devine CJ, Horton CE, Somers KD, Wright GL, Leffell MS, Dawson DM, Gleischman SH, Rowe MJ. Mechanisms of calcification in Peyronie's disease. J Urol 1982; 127:52-4. [PMID: 7057504 DOI: 10.1016/s0022-5347(17)53599-5] [Citation(s) in RCA: 56] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Scanning and transmission electron micrographs demonstrate a calcification process in the penile plaques of patients with Peyronie's disease. Osteoid formation originates from vascular lumina via osteoblast-like cells, which align the calcified plaque. These cells are surrounded gradually by calcified connective tissue. Collagen fibers demonstrate calcification and decreased periodicity.
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37
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Stecker JF, Horton CE, Devine CJ, McCraw JB. Hypospadias cripples. Urol Clin North Am 1981; 8:539-44. [PMID: 7034357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The term "hypospadias cripple" is an apt one. The successful surgery of this condition requires radical correction of all deformities, preferably in a single stage. In doing this one must be conversant with virtually all the existing methods of hypospadias repair and be able to apply them appropriately.
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38
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Abstract
Advancing V-flap dismembered pyeloplasty reconstruction of obstructive ureteropelvic function was used in 31 patients. This modification of the dismembered pyeloplasty compares well in the long-term follow-up when matched with 57 patients treated with other types of dismembered pyeloplasty. Foley Y-V (11 cases), Scardino (4 cases), and Culp (2 cases) pyeloplasties are included in this follow-up of our 105 cases.
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Vande Berg JS, Devine CJ, Horton CE, Somers KD, Wright GL, Leffell MS, Dawson DM, Gleischman SH, Rowe MJ. Peyronie's disease: an electron microscopic study. J Urol 1981; 126:333-6. [PMID: 7196961 DOI: 10.1016/s0022-5347(17)54513-9] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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40
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Horton CE, Devine CJ, Devine PC, McCraw JB, Arganese TJ. Aesthetic reconstructive genital surgery. Clin Plast Surg 1981; 8:399-406. [PMID: 7273639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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41
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Horton CE, Devine CJ, Graham JK. Fistulas of the penile urethra. Plast Reconstr Surg 1980; 66:407-18. [PMID: 6999513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Urethral fistula, the most common complication of urethroplasty, is discussed. There has been no classification for these disorders, and the plethora of reconstruction procedures available often leads to confusion. The classification presented here for acquired fistulas attempts to give direction in the selection of appropriate management in individual cases. Early, acute fistulas are managed conservatively. In the case of mature single fistulas, local tissue may be used for surgical repair. These are subdivided, depending on the size of the opening. Chronic, multiple, large lesions draining the urethra require tissue from a distance for repair. In severe surgical cripples, a total new urethral reconstruction will be required. A new technique to expose the urethra, allowing correction of urethral fistulas with stricture and diverticulum, is described.
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42
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Devine CJ, Horton CE, Scarff JE. Epispadias. Urol Clin North Am 1980; 7:465-76. [PMID: 7404879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Surgical procedures in 14 patients with epispadias not associated with exstrophy of the bladder are reviewed. In the continent patient, repair of epispadias can be accomplished in one stage; however, a multistaged technique is advocated in patients with incontinence or with persistent chordee.
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43
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Duckett JW, Kaplan GW, Woodard JR, Devine CJ. Panel: complications of hypospadias repair. Urol Clin North Am 1980; 7:443-54. [PMID: 6773200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Complications of hypospadias repair result from errors in the initial evaluation of a patient, the design of the operation, the surgical technique, or the postoperative care. The most commonly encountered complications are discussed, with emphasis both on methods of prevention and of treatment.
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44
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Noonan JD, Horton CE, Devine CJ, McCraw JB. Single stage repair of hypospadias. Clin Plast Surg 1980; 7:161-8. [PMID: 7398197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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45
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46
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Devine CJ. Embryology of the male external genitalia. Clin Plast Surg 1980; 7:141-8. [PMID: 7398196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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47
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Calabretta AM, Horton CE, Devine CJ, McCraw JB. Surgical correction of the deviated penis. Clin Plast Surg 1980; 7:201-5. [PMID: 7398200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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48
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Devine CJ, Gonzalez-Serva L, Stecker JF, Devine PC, Horton CE. Utricular configuration in hypospadias and intersex. J Urol 1980; 123:407-11. [PMID: 7188979 DOI: 10.1016/s0022-5347(17)55959-5] [Citation(s) in RCA: 93] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
To evaluate the incidence and significance of an enlarged prostatic utricle in hypospadiac patients without underlying intersex 44 patients with the meatus located in the perineum, penoscrotal junction or proximal two-thirds of the penis were evaluated with cystourethroscopy immediately before the operation. There was an abnormally enlarged utricle in 57 per cent of the perineal, 10 per cent of the penoscrotal and none of the penile hypospadias and intersex revealed a high incidence of enlarged utricle or the presence of a vagina masculinus. Utricular enlargement in itself doses not indicate intersexuality but careful cystoscopic examination of its vault needs to be undertaken, searching for a cervix. An enlarged utricle can be a manifestation of delayed mullerian duct regression or decreased androgenic stimulation of the urogenital sinus.
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49
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Warden SS, Horton CE, Devine CJ. Circumcision as valuable teaching aid in reconstructive urologic surgery. Urology 1979; 14:518-9. [PMID: 388807 DOI: 10.1016/0090-4295(79)90189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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50
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Abstract
We present details of our current techniques for skin graft urethroplasty. We believe that careful attention to the details of these operative techniques is important to their success. The changes from our previous reports include: 1) preparation of patch grafts with rounded ends, 2) preparation of tube grafts with fishmouth spatulation, 3) fixation of the stent catheter to the anterior abdominal wall, 4) leaving a stent catheter inlying for 2 weeks and replacing with a smaller catheter if a voiding cystourethrogram shows extravasation, 5) fixation of the graft during preparation by dermatome adhesive, 6) irrigation of the wound with irrigant before closure and 7) urodynamic flow study for non-invasive postoperative followup.
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