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Biomedical subjects

G H Jordan

Publications and source records attributed to G H Jordan.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1993

Repair of the complications of hypospadias surgery.

In 1992 a retrospective review was conducted of 190 patients evaluated and treated for complications of hypospadias surgery during 1979 through 1990 at the Devine Center for Genitourinary Reconstructive Surgery of Sentara Norfolk General Hospital and Children's Hospital of the King's Daughters. We could not contact 13 patients and 8 are awaiting a second stage procedure. Of the 177 patients 167 (94.35%) have had a successful outcome, defined as a controllable urinary stream, functional erection and an acceptable cosmetic appearance, and 2 (1.13%) are considered failures. Details of presenting problems, surgical techniques and recent modifications of these procedures are presented.

Adolescent↗
PubMed1993

Prepubertal vasal injury: its effect on postpubertal vas deferens.

At this institution, via clinical observation at laparoscopy, a phenomenon was noted in humans that was associated with injury to the prepubertal vas deferens. There were 4 cases that presented with apparent atrophy of the abdominal pelvic portion of the vas deferens following injury to the vas in the prepubertal period. A study was undertaken to see if this phenomenon could be duplicated in an animal model. Prepubertal Sprague-Dawley rats were selected and divided into several groups ranging from sham surgery to unilateral partial vasectomy. These groups allowed for observations following different modes of trauma as well as creation of a control population. Additionally, an adult group was studied to evaluate the effects of vas injury in the adult rat. In the adult group, following trauma to the vas, no changes in the abdominal pelvic portion of the vas were noted. In the prepubertal group, with ligation and with segmental excision (partial vasectomy), striking diminution in outer diameter and wall thickness of the distal vas deferens was noted. This study indicates that the rat prepubertal vas serves as a good model for study of the human vas deferens. Further studies are underway which seek to elicit the mechanism of the observed injury.

Animals↗
PubMed1993

Phallic construction in prepubertal and adolescent boys.

During the last 10 years we performed microsurgical phallic reconstruction in 7 prepubertal and 4 adolescent boys. Indications for surgery included post-traumatic amputation, circumcision accident, developmental anomalies and micropenis. In addition, we performed phalloplasty on 5 other patients 18 to 24 years old. Total phallic reconstruction consisted of 1-stage microsurgical tissue transfers that included urethral reconstruction, coaptation of erogenous nerves, aesthetic refinement and, in some cases, scrotal reconstruction. All postpubertal patients recovered erogenous sensibility in the reconstructed phallus and the ability to masturbate. Surgical indications, techniques and results are discussed.

Adolescent↗
PubMed1993

Laparoscopically assisted continent catheterizable cutaneous appendicovesicostomy.

Described is a case of laparoscopically assisted continent catheterizable cutaneous appendicovesicostomy in a 15-year-old female patient with bilateral ectopic ureteroceles and a totally obliterated bladder neck. The appendix and cecum were mobilized and dissected entirely via laparoendoscopic techniques. The nonrefluxing appendiconeocystostomy required an open cystotomy. The surgical technique and perioperative course are described.

Adolescent↗
PubMed1992

Microsurgical forearm "cricket bat-transformer" phalloplasty.

Presently, the donor flap of choice for microsurgical phallic reconstruction is the radial forearm flap. The success of several different design modifications confirms the reliability of the radial and ulnar forearm flaps. Farrow et al. described their experience with the "cricket bat" concept in 1980. To the previous "cricket bat" design, we now wish to add modifications. These modifications utilize longitudinal and transverse rotations of the linear forearm tissues to create a phallus--much like the transformation of a toy robot into a truck. Deepithelialized flaps and a full-thickness skin graft coronoplasty complete glans reconstruction. The "cricket bat-transformer" flap appears to produce the most predictable results in subtotal phallic reconstructions and phallic constructions in the pediatric and transgender patient groups.

Adult↗
PubMed1992

Premalignant lesions and nonsquamous malignancy of the penis and carcinoma of the scrotum.

Premalignant lesions of the penis include cutaneous horn, balanitis xerotica obliterans, and leukoplakia. The true incidence of progression of each of these to squamous-cell carcinoma is unknown. Bowenoid papulosis, erythroplasia of Queyrat, and Bowen's disease are histologically identical to in situ carcinoma. Although the first is consistently benign, the latter two regularly evolve into invasive cancer. Malignant scrotal lesions include squamous-cell carcinoma, liposarcoma, leiomyosarcoma, basal-cell carcinoma, extramammary Paget's disease, erythroplasia of Queyrat, malignant melanoma, and metastases. Hemangioma can be confused with carcinoma.

Carcinoma↗
PubMed1989

Management of amputation injuries of the male genitalia.

Modern tissue transfer techniques have drastically modified our approach to reconstructive surgery in general. Certainly, the management of traumatic genital amputation is no exception. Although the unique vascular properties of the penis have allowed for astonishingly good results in a number of cases of genital amputation injuries, it is certain that microreplantation procedures make for uniformly good results with a minimum of postoperative complications. After microreplantation, the patient is left with a penis that is cosmetically normal and functionally nearly normal or undetectably abnormal. Although microreplantation offers the best results, certainly in the case of penile amputation, if microreplantation technology is not available, the older corporal reattachment techniques should be offered.

Amputation, Traumatic↗
PubMed1989

Primary realignment of the disrupted prostatomembranous urethra.

Urethral scarring resulting in stricture formation can be avoided or minimized by proper treatment after injury. On presentation of the trauma patient, the possibility of such injury must be suspected and the urethra evaluated prior to any attempts at catheter placement. Diversion in all cases of posterior urethral injury should be by a suprapubic tube, with any urinary extravasation drained at the site of the injury. If the patient's general condition allows it, the disrupted urethra should be realigned by a catheter after the puboprostatic ligaments have been divided. These measures allow the prostate to return to the urogenital diaphragm without tension and in line with the distal urethra. Until the prostate is released, no amount of traction will reapproximate the urethra, and after it is released, traction is not necessary. The suprapubic catheter provides diversion, preventing further complications caused by urinary extravasation; urethral alignment minimizes subsequent stricture formation. When the stricture develops, if it is urodynamically significant, it can be repaired in 4 to 6 months. If one is fortunate, the stricture will be short and amenable to internal urethrotomy. If not, open reconstruction will be greatly facilitated by the attempts to guide the distracted ends of the urethra together.

Erectile Dysfunction↗
PubMed1988

The use of paraexstrophy flaps for urethral construction in neonatal girls with classical exstrophy.

Primary closure of classical exstrophy was performed with paraexstrophy skin flaps for urethral lengthening in 4 female neonates. In all cases more than 2.0 cm. of urethral length were achieved. Efficacy of bladder closure and subsequent bladder neck revision were enhanced by the use of these flaps. The technique of urethral construction is described and our results are discussed.

Bladder Exstrophy↗
PubMed1988

Male genital trauma.

We have attempted to discuss genital trauma in relatively broad terms. In most cases, patients present with relatively minimal trauma. However, because of the complexity of the structures involved, minimal trauma can lead to significant disability later on. The process of erection requires correct functioning of the arterial, neurologic, and venous systems coupled with intact erectile bodies. The penis is composed of structures that are compliant and distensible to the limits of their compliance. These structures therefore tumesce in equal proportion to each other, allowing for straight erection. Relatively minimal trauma can upset this balance of elasticity, leading to disabling chordee. Likewise, relatively minimal injuries to the vascular erectile structures can lead to significantly disabling spongiofibrosis. The urethra is a conduit of paramount importance. Whereas the development of stricture is generally related to the nature of the trauma, the extent of stricture and of attendant complications is clearly a function of the immediate management. Overzealous debridement can greatly complicate subsequent reconstruction. A delicate balance between aggressive initial management and maximal preservation of viable structures must be achieved.

Amputation, Traumatic↗