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Biomedical subjects

K W Angermeier

Publications and source records attributed to K W Angermeier.

At least 19 recordsLinked to original sources
PubMed2000

Cost comparison of radical prostatectomy and transperineal brachytherapy for localized prostate cancer.

OBJECTIVES: To compare perioperative costs associated with radical retropubic prostatectomy (RRP) to transperineal brachytherapy (BXRT) with iodine-125 (125I) seeds in the treatment of localized prostate cancer. METHODS: Actual costs per case for the perioperative period were compiled prospectively for 583 consecutive patients undergoing RRP or BXRT between January 1, 1997 and October 30, 1998 using a hospital-wide cost accounting system. The total cost per case included both technical and professional components. The technical costs included those incurred for anesthesiology, laboratory medicine, medicine, pharmacy, nursing, radiology, 125I seeds, and BXRT technicians. Professional costs included fees from anesthesiology, laboratory, medicine, urology, radiation oncology, and physics. Cases were divided into three groups for analysis: group 1, RRP (n = 404); group 2, BXRT with planning ultrasound performed in the office setting before implantation (n = 107); and group 3, BXRT with planning ultrasound performed in the operating room at the time of implantation (n = 72). Results are reported as relative cost ratios, with RRP assigned a relative cost of 1.0. RESULTS: The total relative perioperative cost for BXRT exceeded that for RRP by 85% to 105%. Technical cost, exclusive of 125I seeds, was substantially lower for BXRT (relative cost 0.36 to 0.42) but was more than offset by the cost of the seeds when comparing total cost with RRP. Performance of the planning ultrasound in the operating room (group 3) increased the total cost by 20%. The categorical technical costs for both BXRT groups were significantly lower for anesthesiology, laboratory medicine, medicine, pharmacy, and nursing but were significantly higher for radiology. The total professional costs were similar for all groups. CONCLUSIONS: Perioperative costs of BXRT with 125I seeds are substantially higher than RRP in the treatment of localized prostate cancer, primarily because of the cost of the seeds.

Brachytherapy↗
PubMed2000

Epithelioid sarcoma of the penis: report of an unusual case and review of the literature.

Epithelioid sarcoma is a rare, slowly growing soft tissue tumor that uncommonly involves the penis, with only 11 previously reported cases. We present a case of penile epithelioid sarcoma in a 39-year-old man that mimicked Peyronie's disease, which was diagnosed 13 years following initial presentation. Preoperative magnetic resonance imaging showed multiple peripherally enhancing low signal intensity nodules involving the corpora cavernosa bilaterally. Following penectomy, histologic examination showed the typical features of epithelioid sarcoma, with a prominent pseudogranulomatous pattern. Immunohistochemically, the neoplastic cells demonstrated strong and diffuse staining for cytokeratins (AE1/AE3 and CAM 5.2), vimentin, epithelial membrane antigen, and CD34. Stains for S-100 protein, desmin, smooth muscle actin, and CD31 were negative. Electron microscopy demonstrated abundant intracytoplasmic intermediate filaments, scattered tonofilaments, and interdigitating filopodia. The present study is the first to describe magnetic resonance imaging and comprehensive immunohistochemical findings in penile epithelioid sarcoma. The majority of cases reported in the literature have demonstrated features similar to those typically found in epithelioid sarcoma involving the distal extremities. Consideration of epithelioid sarcoma in the differential diagnosis of a penile nodule or obstructive urinary symptoms may lead to early diagnosis and treatment.

Adult↗
PubMed2000

A technique of transrectal ultrasound guided transperineal random prostate biopsy in patients with ulcerative colitis and an ileal pouch.

PURPOSE: Prostate biopsy in patients with rectal disease may present a difficult urological problem. We describe a useful technique for the accurate guidance of transperineal random prostate biopsy in patients with colorectal disease. MATERIALS AND METHODS: Biopsy was required in a patient with ulcerative colitis and an ileal pouch who had chronic pouchitis. Biopsy through the pouch was avoided by performing random transperineal prostate biopsies using the ultrasound grid and stabilizing platform used for prostate brachytherapy. RESULTS: Accurate random sampling of the prostate was accomplished. Multiple cores of prostatic tissue were successfully obtained. CONCLUSIONS: Random transperineal biopsy of the prostate was accurately performed under transrectal ultrasound guidance. With the increasing availability of brachytherapy equipment we believe that this method may be used for prostate biopsy in patients with rectal disease.

Biopsy, Needle↗
PubMed1999

Modified corporoplasty for penile curvature: long-term results and patient satisfaction.

PURPOSE: In 1994 we began performing the modified corporoplasty technique in patients undergoing surgery to correct penile curvature. The procedure consists of transverse closure of the longitudinal tunical incisions. This technique allows minimal mobilization of the neurovascular bundles or corpus spongiosum and potentially decreases the risk of injury to underlying erectile tissue. We report long-term results of and patient satisfaction with this procedure. MATERIALS AND METHODS: From June 1994 to June 1997, 28 consecutive patients 16 to 65 years old (mean age 45) selected for corporoplasty underwent a total of 29 operative procedures for disabling penile curvature. The etiology of curvature was Peyronie's disease in 19 patients (68%) and congenital curvature in 9 (32%). Results were obtained by retrospective chart review and telephone interview. Long-term followup available for 19 patients ranged from 11 to 46 months (mean 24.1). RESULTS: Penile straightening was excellent in 25 patients (89%) and good with less than 20 degrees of residual curvature in 2 (7%). In 1 patient in whom the procedure failed excellent straightening was achieved after a repeat procedure. A total of 27 patients (96%) reported no change in erectile rigidity or maintenance postoperatively, while 1 described early detumescence. We contacted 19 patients at long-term followup, of whom 17 and 2 reported excellent and good penile straightening results, respectively. In 18 cases there was no change in erectile rigidity, while in 1 there was early detumescence. Some element of erectile shortening without functional problems was noticed by 11 patients, of whom 1 was bothered by shortening but achieves successful intercourse. Eight patients denied shortening. In regard to the overall result 9 patients were very satisfied, 6 satisfied, 2 neutral and 2 unsatisfied. CONCLUSIONS: In select patients modified corporoplasty as described is an effective and durable procedure with a high rate of patient satisfaction. Patients should be counseled preoperatively concerning postoperative erectile shortening.

Adolescent↗
PubMed1999

Review of Cleveland Clinic experience with penile fracture.

OBJECTIVES: Fracture of the penis is an uncommon injury that results from trauma to the erect penis, usually during sexual intercourse. In some cases, the urethra is injured as well. To determine the outcome of immediate surgical management, we reviewed the cases of 8 patients with fracture of the penis who presented to the Cleveland Clinic from 1992 to 1998. METHODS: Trauma was encountered during intercourse in all our patients. A concomitant urethral injury was found in 3 cases (38%); 1 was a complete disruption, and the other 2 were partial injuries. Patients were treated with immediate surgical exploration and repair, with preoperative urethrography in patients suspected of having a urethral injury. RESULTS: All patients had a successful outcome, with preservation of sexual function and without significant penile curvature. Patients with urethral injuries reported normal voiding without the need for additional procedures. CONCLUSIONS: Immediate surgical repair offers complete recovery for patients with penile fracture in most cases, even in the presence of urethral injury. We present our recommendations for treatment of this condition.

Adult↗
PubMed1998

Management of severe corporeal fibrosis with implantation of prosthesis via a transverse scrotal approach.

PURPOSE: We reviewed our experience in the management of severe corporeal fibrosis with placement of the AMS 700 CXM* prosthesis to determine the efficacy of this approach. MATERIALS AND METHODS: The records of 26 men with severe corporeal fibrosis who underwent placement of the AMS 700 CXM prosthesis via a transverse scrotal approach between August 1991 and July 1996 were reviewed. RESULTS: In all cases the AMS 700 CXM prosthesis was successfully implanted with primary closure of the tunica albuginea, although 2 patients required extended corporotomies. Followup data were available on all 26 men. At a mean followup of 22.5 months (range 3 to 63) 24 of the 26 men had a functional device (92%). One patient required explantation for infection and 1 underwent explantation for cylinder cross-over. CONCLUSIONS: Implantation of the AMS 700 CXM prosthesis in patients with severe corporeal fibrosis produced good results at approximately 2 years of followup.

Adult↗
PubMed1997

Long-term mechanical reliability of AMS 700 series inflatable penile prostheses: comparison of CX/CXM and Ultrex cylinders.

PURPOSE: Recently, we have noted an increasing incidence of revisions being performed in patients implanted with the length and girth expanding AMS 700 Ultrex* inflatable penile prosthesis. This observation prompted us to compare the long-term mechanical reliability of the AMS Ultrex inflatable penile prosthesis versus the girth-expanding AMS 700 CX* or CXM* inflatable penile prosthesis in men with organic erectile dysfunction. MATERIALS AND METHODS: Using chart review, mailed questionnaires and telephone interviews, we obtained accurate followup on 111 of 142 (78.2%) patients with CX/CXM implanted between June 1986 and September 1995, and on 152 of 179 (84.9%) patients implanted with Ultrex between October 1989 and September 1995. The CX/CXM and Ultrex groups were compared with regard to 3 end points: 1) mechanical failure caused by any malfunctioning component, 2) device failure caused by any cylinder complication and 3) cylinder aneurysms/leaks. RESULTS: Followup ranged from 1.0 to 112.0 months for the CX/CXM group (mean 47.2 months), and 0.7 to 71.5 months for the Ultrex group (mean 34.4 months). CX/CXM versus Ultrex group comparison demonstrated 10 CX/CXM mechanical failures (9.0%) versus 26 Ultrex failures (17.1%), p = 0.001; 5 CX/CXM cylinder complications (4.5%) versus 13 Ultrex cylinder complications (8.6%), p = 0.0292; and 3 CX/CXM cylinder aneurysms/leaks (2.7%) versus 9 in the Ultrex group (5.9%), p = 0.0162. Kaplan-Meier estimates demonstrated significantly decreased mechanical survival in all 3 categories for Ultrex inflatable penile prosthesis versus CX/CXM inflatable penile prosthesis. CONCLUSIONS: Although Ultrex cylinders provide length and girth expansion, Ultrex cylinders exhibit an increased mechanical failure rate at shorter followup compared with CX/CXM cylinders. This increased propensity for Ultrex cylinder problems should be closely monitored.

Humans↗
PubMed1996

AMS 3-piece inflatable penile prosthesis implantation in men with Peyronie's disease: comparison of CX and Ultrex cylinders.

PURPOSE: We compared the ability of the CX and Ultrex cylinders to straighten the penis in men who received a 3-piece AMS 700 series inflatable penile prosthesis for erectile dysfunction and erectile deformity due to Peyronie's disease. MATERIALS AND METHODS: The records of 34 and 38 patients receiving devices CX and Ultrex cylinders, respectively, were reviewed. RESULTS: All 34 patients receiving the CX cylinders achieved complete penile straightening with cylinder inflation and bending alone. In 10 of 38 patients receiving the Ultrex cylinders complete straightening with cylinder inflation and bending could not be achieved, and simultaneous corporoplasty was necessary. CONCLUSIONS: Girth expanding CX cylinders have better penile straightening properties than girth and length expanding Ultrex cylinders. We recommend use of CX cylinders for 3-piece AMS 700 series inflatable penile prosthesis implantation in men with Peyronie's disease.

Adult↗
PubMed1995

Cultures from genitourinary prostheses at reoperation: questioning the role of Staphylococcus epidermidis in periprosthetic infection.

PURPOSE: We determine the colony counts of organisms present on culture of clinically uninfected genitourinary prostheses at reoperation for reasons other than infection. These results served as control data for comparison with cultures from infected devices to determine the relative incidence of organisms involved. MATERIALS AND METHODS: Cultures were prospectively obtained from 65 penile prostheses and 22 artificial urinary sphincters. Patients were followed for a minimum of 12 months after reoperation or until development of infection (mean 27 months) at which time cultures were again obtained. RESULTS: Low colony counts of Staphylococcus epidermidis were isolated from 40% of uninfected penile prostheses and 36% of artificial urinary sphincters. Only 3 of these devices later became infected (9%) and in all cases a higher colony count of another organism was found at explanation. CONCLUSIONS: While Staph. epidermidis can cause prosthesis infection, low colony counts of the organism may not be associated with clinical infection. Therefore, the high incidence of infection attributed to this organism may be overestimated.

Case-Control Studies↗
PubMed1994

Renal cell carcinoma arising in a regressed multicystic dysplastic kidney.

Controversy surrounds the management of multicystic dysplastic kidney. Recent advances in radiological imaging have resulted in a higher incidence of its detection, and they provide an accurate noninvasive means of diagnosis and followup. Consequently, the need for surgical removal of these lesions is being reevaluated. We report a case of renal cell carcinoma arising from solid renal dysplasia associated with a regressed multicystic dysplastic kidney. We emphasize the potential risk of nonoperative management of these lesions and further define the spectrum of malignant degeneration associated with renal dysplasia.

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

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

Penile venous ligation in 18 patients with 1 to 3 years of followup.

We report the results of penile venous ligation in 18 consecutive patients with erectile insufficiency due to corporeal venous occlusive dysfunction. Patient age ranged from 25 to 65 years (mean 47). Duration of erectile dysfunction ranged from 9 to 468 months (mean 95) and followup ranged from 12 to 37 months (mean 24). Of 18 patients 11 (61%) have sufficient persistent improvement in erections to permit unaided coitus. Of 7 failures 6 had temporary improvement in erections after the procedure: in 5 the improvement lasted 6 months or less, while only 1 had lasting improvement (24 months) before relapse. Reports of results of penile venous ligation should not include patients who have been followed for less than 12 months. Longer followup is needed before results of penile venous ligation beyond 2 years are known.

Adult↗