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C J Devine

Publications and source records attributed to C J Devine.

At least 37 records · Page 2Linked to original sources
PubMed1988

An evaluation of skin grafts for reconstruction of the penis and scrotum.

Skin grafting remains a primary modality for reconstruction of genitourinary defects. Many of these conditions are discussed and emphasis has been placed on the different indications for full-thickness, split-thickness, and dermal grafts. Complications have been few, and long-term results excellent. This experience has allowed the formulation of a number of surgical principles, which are presented. Refinements in reconstruction are currently being evaluated to obtain the optimal result.

Bladder Exstrophy↗
PubMed1987

Müllerian duct cysts: conservative management.

Three cases of the unusual entity, müllerian duct cyst, are presented. Each was managed differently, demonstrating that with appropriate patient selection either aspiration alone, aspiration and instillation of a sclerosing agent, or transurethral resection of bladder base to establish communication and cyst drainage are successful.

Adolescent↗
PubMed1987

Chromosome abnormalities in Peyronie's disease.

Peyronie's disease is a localized and progressive fibrosis of unknown etiology that affects the tunica albuginea of the penis. We examined cytogenetically cell cultures derived from plaque, adjacent tunica, dermis and lymphocytes in patients with Peyronie's disease, and compared the results to cell cultures established from the tunica albuginea of control patients. Chromosomal abnormalities were detected in 9 plaque-derived cell cultures from 7 of 12 Peyronie's disease patients (58 per cent). Cells cultured from adjacent tunica, dermis and lymphocytes from the same patients were karyotypically normal, as were cultures derived from control (chordee and penile scar) patients. Chromosomal aberrations consisted of 5 numerical changes and 4 structural rearrangements, and included chromosomal additions (trisomy 7 and trisomy 8), deletions (45X,-Y), reciprocal translocations and inversions or markers. In 2 instances cultures derived from plaque tissue contained 2 independent chromosomal abnormalities. The apparently random chromosomal changes associated with Peyronie's disease suggests that karyotypic instability may be a common feature of cells within the plaque. It presently is unclear whether this finding represents multiple pathways for the development of Peyronie's disease or secondary consequences of Peyronie's disease.

Aged↗
PubMed1987

Peyronie's disease.

More than 16 years' experience with approximately 1,000 cases of Peyronie's disease and a review of 110 patients evaluated more than 1 year postoperatively are presented. Peyronie's disease is difficult to treat. There is no known etiological agent, and because occasional spontaneous disappearance of the lesion occurs, the assessment of therapy is difficult. Our operation has been successful in relieving penile curvature and pain in a substantial number of patients (84%). Therefore, we recommend that in all severe, sexually disabling cases of Peyronie's disease unresponsive to conventional therapy, excision of the diseased tunica albuginea and replacement with dermal graft be considered. Organic impotence, which is occasionally seen preoperatively in association with Peyronie's disease, requires thorough investigation, sex counseling, and consideration of a penile implant.

Erectile Dysfunction↗
PubMed1987

New concepts in phallic reconstruction.

Over the past four years we have performed total phallic reconstructions in 12 patients. Six patients underwent reconstruction following trauma, 3 were female-to-male transsexuals, and 3 had micropenis deformities. These reconstructions were one-stage microsurgical tissue transfers that included urethral reconstruction and coaptation of erogenous nerves. The surgical indications, techniques, and results are discussed.

Adult↗
PubMed1987

Current hypospadias techniques.

Hypospadias repairs must encompass straightening of the penis and construction of the neourethra at the tip of the penis. In addition to an outline of preoperative and postoperative management, five techniques of single-stage surgical repair are discussed. All hypospadias defects can be repaired using one of these five basic procedures.

Humans↗
PubMed1987

Bent penis.

Explore the source record for details and available documents.

Humans↗
PubMed1986

Urinary bladder reinnervation.

The ability of mixed spinal nerve roots to regenerate and reinnervate the urinary bladder was examined in young adult female cats. Using microsurgical technique, a unilateral extradural spinal nerve root anastomosis of a lumbar (L7) to a sacral root (S1) either with or without a nerve graft was performed. Remaining ipsilateral sacral roots were transected. The contralateral normal sacral roots remained intact and allowed the animals adequate urination during the period necessary for axonal regeneration. At the time of restudy seven months later, stimulation of the anastomosed nerve root proximal to the anastomosis (isolated from the spinal cord) elicited a bladder contraction. Significant lumbar axonal regeneration was substantiated by compound action potentials recorded across the anastomosis. In addition, redirection of axons from a lumbar to a sacral distribution was demonstrated. The contralateral normal sacral roots provided control cystometric and electrophysiological data against which responses from the previously anastomosed nerve roots were compared. In conclusion, significant bladder reinnervation can occur after an anastomosis of a lumbar and sacral root with or without a nerve graft. This technique, or variations thereof, may have a clinical role in selected patients with neurogenic bladder dysfunction to reinnervate the bladder and restore central control.

Animals↗
PubMed1986

Microsurgical hypospadias repair.

Successful primary hypospadias repair depends on careful execution of surgical principles, particularly during the urethroplasty portion of the procedure. These principles include careful tissue handling, development of well-vascularized flaps, and avoidance of placing sutures in the uroepithelial surface. Despite meticulous repair, the complication rate requiring secondary surgery is 15 to 30 percent. For the past year, the authors have utilized an operating room microscope, microsurgical instruments, a specially designed microsuture, and a Biooclusive dressing to decrease the postoperative morbidity and subsequent complications requiring secondary surgery (6.5 percent). A comparison of 50 hypospadias patients on whom no microsurgical repair had been used was made with 62 patients on whom microsurgical techniques were employed. The nonmicrosurgical group had 17 complications, 12 of which required reoperation (24 percent). The microsurgical group had 8 complications, 4 of which required reoperation (6.5 percent).

Child, Preschool↗
PubMed1985

Urethroplasty using diverticular tissue.

Diverticula that occur in the neourethra following repair of hypospadias, epispadias or urethral stricture generally are associated with obstruction distal to the dilated segment. This diverticular tissue can be moderately elastic and well vascularized. We have been able to relieve the stenosis by developing and advancing a diverticular flap, simultaneously reducing the size of the diverticulum.

Adolescent↗
PubMed1985

Penile curvatures.

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.

Humans↗
PubMed1985

Intraoperative consultation for the urethra.

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.

Female↗
PubMed1984

Evaluation of erectile dysfunction in patients with Peyronie's disease.

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.

Erectile Dysfunction↗
PubMed1984

The treatment of psychogenic impotence after dermal graft repair for Peyronie's disease.

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.

Coitus↗
PubMed1983

Urethral hemangioma: treatment by total excision and grafting.

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.

Adolescent↗
PubMed1982

Posterior urethral injuries associated with pelvic fractures.

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.

Erectile Dysfunction↗