Biomedical subjects
Publications and source records attributed to C J Devine.
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.
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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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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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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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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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.
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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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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Peyronie's disease is characterized by localized fibrosis in the tunica albuginea of the corpus cavernosum. This inelastic segment causes bending of the erect penis and sexual incapacity in advanced cases. We reviewed 52 cases in which excision of the Peyronie's plaque and replacement of the defect with a dermal graft have been done. An operation is an acceptable method to treat patients who are anatomic and sexual cripples. More than 70 per cent of our postoperative patients have been satisfied with sexual performance. Specific aspects of the postoperative course and surgical results are reviewed.
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.