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Biomedical subjects

H Wessells

Publications and source records attributed to H Wessells.

32 records · Page 2Linked to original sources
PubMed1998

Current controversies in anterior urethral stricture repair: free-graft versus pedicled skin-flap reconstruction.

Reconstruction of long anterior urethral strictures that cannot be excised and reanastomosed remains controversial. We critically reviewed the literature on free-graft and pedicled skin-flap urethroplasty to determine the optimal method of repair. Overall, free grafts were successful in 84.3% of cases and flaps, in 85.9%. Buccal mucosa grafts are the most successful method for reconstruction of bulbar urethral strictures. For strictures in the penile urethral or a compromised graft bed a distal penile skin flap is the most reliable and tested approach. Dorsal free-graft urethroplasty may be considered when penile skin deficiency prevents use of a flap. For the most complex strictures, in which a flap is not possible and the graft bed is of poor quality, a mesh graft in two stages may be the only option. Thus, for reconstruction of complex anterior urethral strictures, both free-graft and flap procedures remain indispensable.

Evaluation Studies as Topic↗
PubMed1998

Synthetic melanotropic peptide initiates erections in men with psychogenic erectile dysfunction: double-blind, placebo controlled crossover study.

PURPOSE: We evaluated the erectogenic properties of a new cyclic alpha-melanocyte-stimulating hormone analogue, Melanotan-II, to treat men with psychogenic erectile dysfunction. MATERIALS AND METHODS: Ten men with erectile dysfunction of no known organic cause were entered in a double-blind, placebo controlled crossover study in which the erectogenic properties of Melanotan-II and a vehicle placebo were compared using real-time RigiScan monitoring. The presence, duration and rigidity of erections were recorded during a 6-hour period. RESULTS: In 8 of 10 men treated with Melanotan-II clinically apparent erections developed. Mean duration of tip rigidity greater than 80% was 38.0 minutes with Melanotan-II and 3.0 with placebo (p=0.0045). Transient side effects of nausea, stretching and yawning, and decreased appetite were reported more frequently after injections of Melanotan-II than placebo but none required treatment. CONCLUSIONS: Melanotan-II is a potent initiator of erections in men with psychogenic erectile dysfunction and has manageable side effects at a dose of 0.025 mg./kg.

Abdominal Muscles↗
PubMed1998

Obliterative vesicourethral strictures following radical prostatectomy for prostate cancer: reconstructive armamentarium.

PURPOSE: We report the reconstructive techniques used to correct obliterative vesicourethral strictures related to prostate cancer surgery. MATERIALS AND METHODS: Four men with anastomotic obliteration after radical prostatectomy underwent primary excision with end-to-end anastomosis, penile fasciocutaneous flap, free-graft urethroplasty with rectus muscle flap or anterior bladder tube with omental pedicle flap procedure. RESULTS: At mean followup of 33.8 months all patients had urethral patency but none was continent. CONCLUSIONS: Single stage reconstruction of the obliterated vesicourethral anastomosis after prostatectomy successfully restored urethral patency. No technique was applicable in all cases. Sphincteric function is likely to be compromised after the primary procedure, resulting in incontinence after successful urethral reconstruction. Subsequent artificial sphincter placement appears to be safe and helpful in restoring continence.

Aged↗
PubMed1997

Criteria for nonoperative treatment of significant penetrating renal lacerations.

PURPOSE: We developed criteria for nonoperative treatment of penetrating renal injuries and predicting which patients will benefit from immediate surgery. MATERIALS AND METHODS: We reviewed the records of 120 patients with grades 2 to 4 renal lacerations from gunshot and stab wounds, of whom 41 were treated nonoperatively (group 1) and 79 underwent immediate renal exploration (group 2). RESULTS: Group 1 had significantly lower incidences of gunshot wounds, shock, associated injuries, need for transfusion and high grade renal injuries. In patients with grade 2 lacerations no complications resulted from nonoperative treatment. However, 23.5% of patients in group 1 with grades 3 and 4 injuries had delayed renal bleeding versus none in group 2. CONCLUSIONS: Nonoperative treatment of penetrating renal lacerations is appropriate in hemodynamically stable patients without associated injuries. Grade 2 injuries can be treated nonoperatively but grades 3 and 4 injuries are associated with a significant risk of delayed bleeding if treated expectantly. Exploration should be considered if laparotomy is indicated for other injuries.

Adolescent↗
PubMed1997

Preservation of renal function after reconstruction for trauma: quantitative assessment with radionuclide scintigraphy.

PURPOSE: We quantified the degree of preservation of renal function after reconstruction of traumatic renal injuries and identified the factors that influence preservation. MATERIALS AND METHODS: We reviewed the records of 52 patients between 1977 and 1995 who underwent radionuclide scintigraphy an average of 11.4 days after renal reconstruction for trauma. Of the injuries (75% penetrating and 25% blunt) 6% were grade 2, 43% grade 3, 49% grade 4 and 2% grade 5. RESULTS: On the reconstructed side mean renal function was 39.3%. Adequate preservation was possible in 42 patients (81% overall), while 10 (19%) had less than a third function on the injured side. CONCLUSIONS: Our results provide quantitative evidence that renal reconstruction successfully preserves functioning renal tissue and is an appropriate method of treating major renal trauma. Preservation of functioning renal parenchyma is less successful in patients with renovascular trauma and severe concomitant injuries with shock and extensive blood loss.

Adolescent↗
PubMed1997

Single stage reconstruction of complex anterior urethral strictures: combined tissue transfer techniques.

PURPOSE: Reconstruction of most urethral strictures is possible with anastomotic, graft or skin flap procedures alone. We describe the combination of tissue transfer techniques to preserve the urethral plate and reconstruct long and complex urethral strictures in 1 stage. MATERIALS AND METHODS: We reviewed the results in 25 patients who underwent anterior urethroplasty requiring more than 1 tissue transfer technique to achieve urethral reconstruction in 1 stage. RESULTS: Outcome was excellent in 22 patients (88%). Seven patients with pan-urethral strictures (mean length 19 cm.) required a fasciocutaneous flap combined with a buccal mucosa, bladder epithelium or skin graft. A total of 13 patients with focally dense strictures underwent excision of the most severe portion of the stricture with dorsal reapproximation, thereby improving the quality of the urethral plate and allowing simultaneous flap or graft onlay reconstruction. Five patients with multiple separate strictures required a distal onlay fasciocutaneous flap with excision and end-to-end anastomosis of a separate, more proximal stricture. CONCLUSIONS: A thorough knowledge of the vascular supply of the urethra allowed creative application of different tissue transfer techniques, enabling 1-stage reconstruction of complex urethral strictures. An excellent outcome was achieved by preserving or revising the urethral plate and avoiding the problems associated with hair-bearing flaps and 2-stage procedures.

Adult↗
PubMed1996

Effect of colon injury on the management of simultaneous renal trauma.

PURPOSE: We determined the effect of simultaneous colon injury on the management of renal trauma. MATERIALS AND METHODS: A retrospective review was done of 62 cases of colon and renal injuries from 1977 to 1994, representing 2.5% of 2,596 renal trauma cases. RESULTS: Renal trauma management was consistent with the grade of renal injury. Renal exploration was performed in 58% of the cases, with nephrectomy performed in 16% of the explorations and only for severely injured kidneys. Urological complications occurred in 16% of the cases but they resulted in loss of only 1 renal unit. CONCLUSIONS: Renal injury and reconstruction should not be treated differently in the face of colon injury, including gross fecal contamination.

Adult↗
PubMed1996

Use of free grafts in urethral stricture reconstruction.

PURPOSE: The indications, contraindications and results of free graft urethroplasty are determined. MATERIALS AND METHODS: A retrospective review was done of 40 consecutive patients who underwent free graft urethroplasty with penile and preputial skin, buccal mucosa and bladder epithelium. RESULTS: Of the 35 patients in whom adequate followup data were available the outcome was successful in 30 (86%). Success was unrelated to donor site, prior intervention or cause of stricture. Failure was attributed to placement of grafts onto the penile urethra and patient age. CONCLUSIONS: For strictures in the bulbar urethra the success rate of free grafts was high. Failures occurred in patients in whom full thickness skin grafts were extended far onto the penile urethra.

Adult↗
PubMed1996

Complications of penile lengthening and augmentation seen at 1 referral center.

PURPOSE: Complications of the recent cosmetic technique of penile lengthening and girth enhancement are reviewed. MATERIALS AND METHODS: During a 16-month period 12 men presented with complications of penile augmentation performed elsewhere. All 12 patients had undergone release of the suspensory ligament and 10 had received autologous fat injection. RESULTS: The chief complaint was poor cosmetic appearance (irregular residual fat nodules in 7 men, skin deformity and scarring in 4 and scrotalization in 4). Reoperation was necessary in 6 patients, wound complications occurred in 6 and sexual dysfunction was reported by 4. Only 1 patient reported a subjective increase in penile length. CONCLUSIONS: Although a verifiable complication rate may never be available, the morbidity of elective penile lengthening and girth enhancement is noteworthy. These cosmetic techniques should be regarded as experimental.

Adult↗
PubMed1996

Penile length in the flaccid and erect states: guidelines for penile augmentation.

PURPOSE: We provide guidelines of penile length and circumference to assist in counseling patients considering penile augmentation. MATERIALS AND METHODS: We prospectively measured flaccid and erect penile dimensions in 80 physically normal men before and after pharmacological erection. RESULTS: Mean flaccid length was 8.8 cm., stretched length 12.4 cm. and erect length 12.9 cm. Neither patient age nor size of the flaccid penis accurately predicted erectile length. Stretched length most closely correlated with erect length. CONCLUSIONS: Only men with a flaccid length of less than 4 cm., or a stretched or erect length of less than 7.5 cm. should be considered candidates for penile lengthening.

Adult↗
PubMed1996

Circular penile fasciocutaneous flap reconstruction of urethral strictures: technical considerations and results in 40 patients.

The reconstruction of complex anterior urethral strictures has evolved from free graft urethroplasty to the use of vascularized skin flaps. The circular penile fasciocutaneous flap is based on Buck's fascia, is hairless, and reliably provides 15 cm of skin. We have used this technique in 40 patients with urethral strictures from the fossa navicularis to the veru montanum. Indications include severe spongiofibrosis, penile urethral location, inflammatory or ischemic etiology, and need for complete tube replacement. A successful result was obtained in 85% of patients. Complete tube replacement is less successful than onlay type procedures (77% vs. 96%) and we make every effort to preserve the urethral plate. This technique is the mainstay of our armamentarium for the repair of urethral strictures and also allows an excellent cosmetic result.

Follow-Up Studies↗