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Biomedical subjects

G H Jordan

Publications and source records attributed to G H Jordan.

At least 19 recordsLinked to original sources
PubMed1999

Penile reconstruction, phallic construction, and urethral reconstruction.

Penile reconstruction, phallic construction, and urethral reconstruction require tissue transfer in the majority of cases. This article discusses the techniques of tissue transfer and presents illustrative cases of penile reconstruction, total phallic construction, and urethral reconstruction. The modified forearm flaps for penile reconstruction, the ulnar forearm flap as used for total phallic construction, and the dartos fascial flap and penile skin islands for urethral reconstruction are illustrated. Graft onlay techniques also are shown.

Adult↗
PubMed1999

Erectile function and dysfunction.

The advent of "the pill" for erectile dysfunction has prompted discussion in the news as well as jokes on late-night talk shows. However, the underlying causes of the condition are complex, and no single treatment is right for all patients. To select the best therapy for each patient, it is important to understand how an erection works and how the available treatments address the various causes of dysfunction. Dr Jordan presents a comprehensive, straightforward (sometimes humorous) look at the mechanisms involved in erectile function and offers an approach to management of dysfunction.

Erectile Dysfunction↗
PubMed1998

[Reconstruction of meatus/fossa navicularis using skin flap technique].

The author discusses the procedures for reconstruction of the meatus and fossa navicularis. The author describes four separate procedures for reconstruction using vascularized skin island. The choice of the procedure depends on the anatomy of the stricture as well as the anatomy of the redundancy of penile skin.

Humans↗
PubMed1998

[Fundamentals and basic principles of tissue transfer].

The advancements in tissue transfer techniques made recent years allow the reconstructive surgeon to view the whole body as a potential donor site. Now functional results, along with cosmetic results, can be considered as paramount in the thinking of the reconstructive surgeon. In the past, techniques of tissue transfer tended to be considered in ladder fashion with the surgeon applying techniques of transfer from simplest to "exotic" as opposed to considering optimal functional/cosmetic results. Now reconstructive surgeons routinely consider the "exotic" when it yields the best functional/cosmetic results. The basic that will be discussed in this chapter are designed to provide a platform from which GU reconstructive surgeon launches into more complex and imaginative procedures.

Animals↗
PubMed1997

Laparoscopic pyelolithotomy.

Laparoscopic surgery has been applied to virtually every aspect of urinary tract disease. Presented is a case of laparoscopic-extended pyelolithotomy accomplished in a 16-month-old child with a large cystine stone that occupied the child's entire renal pelvis. Although not the first pyelolithotomy accomplished laparoscopically, we believe this to be the first extended laparoscopic pyelolithotomy and also believe this is the youngest patient in whom laparoscopic pyelolithotomy has been done. Extracorporeal shock wave lithotripsy and percutaneous and endoscopic stone techniques have drastically modified the management of urolithiasis. However, select cases in which these techniques may not be applicable (such as this toddler with bulky cystine lithiasis) may require open surgery. The laparoscopic approach represents an excellent, yet less-invasive option.

Female↗
PubMed1997

Laparoscopic management of persistent Müllerian duct remnants associated with an abdominal testis.

In recent years, laparoscopy has evolved from a purely diagnostic procedure in the management of nonpalpable testis to a definitive therapeutic intervention. Additional genital malformations occur in association with cryptorchidism, but reports of laparoscopic management of such entities do not exist. Herein, we describe the laparoscopic removal of persistent Müllerian duct remnants (uterus and round ligament) in combination with an orchiectomy of an abnormally small abdominal testis. This technique expands the versatility of laparoscopic management of cryptorchidism to include the resection of associated congenital anomalies.

Abdomen↗
PubMed1996

The role of colpocleisis with urethral lengthening in transsexual phalloplasty.

OBJECTIVE: Transsexual surgery is an unique area of rarely performed surgery. This study examines factors that have significance in the prevention of major morbidity in this unusual surgery. The role of the gynecologist in the psychologic, endocrine, and operative management is presented. STUDY DESIGN: Initial operations were complicated by fistulas at the urethra-to-phallus anastomosis site. After reviewing these complications, we modified our approach to include a two-stage procedure allowing for healing before microsurgery and sparing of the anterior vaginal wall during vaginal hysterectomy and colpocleisis. By sparing the anterior vaginal wall, we were able to better extend the urethra for later phallus attachment. RESULTS: Using the two-stage procedure at colpocleisis allowed a significant reduction in the fistula rate. (p = 0.0087) with the effective elimination-fistulas, the use of stiffeners during phalloplasty for better functional results is possible. CONCLUSION: Extending the urethra during colpocleisis allows for better healing and significantly decreased fistula formation. Proper blood supply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results.

Female↗
PubMed1994

Laparoscopic single stage and staged orchiopexy.

The initial series of laparoscopic single stage orchiopexy for the abdominal or emergent impalpable undescended testis is reported. The first laparoscopic orchiopexy was performed at our institution in October 1991. Between October 1991 and January 1993, 14 patients (16 testes) underwent minimally invasive surgery with 6 months of followup in all cases. No evidence of testicular loss or acute atrophy has occurred, with the entire procedure being accomplished by laparo-endoscopic techniques in all cases. Treatment of 3 of the 16 testicles consisted of stage 2 of staged orchiopexy, and to our knowledge these cases represent the first stage 2 orchiopexy completed by laparoscopic techniques. In those cases stage 1 was performed by laparoscopic clipping of the vessels. The details of the procedure as we now perform it are described.

Adolescent↗
PubMed1994

Penile prosthesis implantation in total phalloplasty.

A series is presented of 8 patients who had undergone either total phalloplasty or free flap penile reconstruction. Our experience with prosthetic implantation is reviewed as is a brief history of phallic construction, including previously reported efforts at achieving rigidity with prosthetic implantation, autologous material implantation and so forth. We present in detail our current technique of implantation in these 8 patients, who underwent 10 attempts at implantation. In 4 patients infection necessitated removal of the prosthesis (2 have since undergone successful reimplantation). Of the 8 patients in whom implantation was attempted 6 (60%) currently have prostheses in place.

Adolescent↗
PubMed1994

Complications of the exaggerated lithotomy position: a review of 177 cases.

To examine the incidence and nature of complications associated with placing patients in the exaggerated lithotomy position, a retrospective review of 177 procedures requiring the use of that position was done. Factors analyzed were patient age, height, weight and time in position. Height-to-weight ratio was calculated in an effort to establish a relationship between body habitus and common peroneal nerve neurapraxia, the most common complication (15.8%) noted in the study. Statistical analysis failed to show any relationship between these factors and the incidence of neurapraxic complications. The study demonstrates the safety of this highly useful surgical position for perineal operations. The technical points relative to positioning are emphasized.

Adolescent↗
PubMed1994

Complex urethral reconstruction.

Modern tissue transfer techniques, often incorporating penile or scrotal skin islands based on a dartos fascia pedicle, have revolutionized urethral reconstruction. There are certain situations, however, that require a more creative and complex approach. The majority of these cases involve patients with panurethral stricture disease or those who have undergone multiple previous procedures for urethral stricture disease or hypospadias and their subsequent complications. In this article, the authors discuss the various aspects of these two conditions and outline several techniques for urethral reconstruction in these challenging patients.

Adult↗
PubMed1993

Laparoendoscopic upper pole partial nephrectomy with ureterectomy.

A 14-year-old white girl presented with a history of recurrent urinary tract infections beginning at age 18 months. Anatomical evaluation revealed bilateral duplication of the collecting systems. On the right side of the upper pole moiety ended at an obstructing orthotopic ureterocele. On the left side the upper pole moiety was associated with an ectopic ureteral orifice. The patient underwent laparoendoscopic right upper pole partial nephrectomy with ureterectomy. To our knowledge this is the first report of a laparoendoscopic upper pole partial nephrectomy. Details of the procedure are discussed.

Adolescent↗
PubMed1993

Preoperative evaluation of erectile function with dynamic infusion cavernosometry/cavernosography in patients undergoing surgery for Peyronie's disease: correlation with postoperative results.

Most reports of surgical therapy for Peyronie's disease to date have not included detailed preoperative assessment of erectile function. To evaluate the relationship between preoperative erectile function and postoperative success, we reviewed 25 consecutive patients with Peyronie's disease who underwent surgery and evaluation with dynamic infusion cavernosometry and cavernosography preoperatively. Overall results of dynamic infusion cavernosometry and cavernosography revealed corporeal veno-occlusive dysfunction in 76% of the patients and inadequate arterial inflow parameters in 44%. Among 20 patients treated with plaque excision and dermal graft inlay, adequate postoperative erectile function for satisfactory intercourse occurred in 4 of 4 (100%) with an equilibrium accumulated intracorporeal pressure of greater than or equal to 70 mm. Hg, 9 of 12 (75%) with an equilibrium accumulated intracorporeal pressure of 40 to 65 mm. Hg and 1 of 4 (25%) with an equilibrium accumulated intracorporeal pressure of less than 35 mm. Hg. These data may be helpful to counsel patients before surgical therapy, and may explain some of the disparate results previously reported after plaque excision and dermal graft inlay on the basis of patient selection.

Alprostadil↗