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.     

Long-term experience with controlled expansion cylinders in the AMS 700CX inflatable penile prosthesis and comparison with earlier versions of the Scott inflatable penile prosthesis

OBJECTIVEs. To determine complication and survival rates of the AMS 700CX penile prosthesis and to compare its reliability with earlier versions of the Scott inflatable penile prosthesis. METHODS: Retrospective chart review and telephone interviews were used. RESULTS: Actual 4-year survival of the AMS 700CX device was 85%, whereas earlier versions of the device had actual 4-year survival of 46% (p < 0.0001). The observed difference in prosthesis reliability could not be accounted for by differences in patient population, surgical technique, or incidence of infections. The most significant factor that contributed to improved prosthesis survival was the lack of cylinder complications (leaks and aneurysms). CONCLUSIONS: The controlled expansion cylinders of the AMS 700CX penile prosthesis are a significant advance in reliable, low-morbidity surgical therapy for impotence.     

Radical prostatectomy in patients with indwelling inflatable penile prosthesis

Patients with impotence who have undergone placement of an inflatable penile prosthesis (IPP) and then subsequently are diagnosed with carcinoma of the prostate (CaP) present a surgical dilemma. We performed radical retropubic prostatectomy on 3 patients with clinically localized CaP and an indwelling IPP. At laparotomy all 3 patients had the IPP reservoir relocated to facilitate dissection. In each case the reservoir was relocated to the left hypogastrium within the extraperitoneal space without disrupting the vacuum tubing system. There were no complications related to IPP, no IPP was injured, and each IPP was reactivated successfully 6 weeks after surgery.     

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.     

Prevention and treatment of complications of inflatable penile prosthesis surgery: a review article

Over the last 16 years more than 3,000 procedures involving multi-component inflatable penile prosthesis have been performed. A variety of types of complications have been encountered, including mechanical problems with the prosthesis, intraoperative complications, postoperative complications, problems with infection and patient dissatisfaction. During the course of this experience we have made some observations and developed techniques to minimize and treat the complications seen with both routine and difficult inflatable penile prosthesis implantation surgery.     

Gangrene of the penis after implantation of penile prosthesis: case reports, treatment recommendations and review of the literature

We report 3 cases of gangrene of the penis seen at our institution after penile prosthesis implantation. All 3 patients had insulin-dependent diabetes mellitus. Amputation was required in 2 patients. Aggressive debridement in conjunction with hyperbaric oxygen prevented amputation in the third patient.     

Buckling of cylinders may cause prolonged penile pain after prosthesis implantation: a case control study using magnetic resonance imaging of the penis

The evidence for a significant genetic contribution to the functional psychoses (schizophrenia and bipolar disorder) is now well established. However, in both cases, the non-mendelian mode of inheritance has made the identification of susceptibility loci particularly challenging. The neuropeptide cholecystokinin (CCK) is present both in the gut and the CNS. Studies of CCK-like immunoreactivity and CCK mRNA levels in human brains have revealed high concentrations in numerous loci and shown colocalisation of CCK with, for example, dopamine and tyrosine hydroxylase. Furthermore, antagonists of CCK-B receptors, which are found most frequently in the brain, inhibit the activity of brain dopamine neurons. Such findings suggest that, with respect to neuropsychiatric disorders, CCK is a suitable candidate for analysis using methods to detect gene variations which have the potential to affect protein structure or expression. In the present study, mutation analyses were carried out on the human CCK gene. Linked polymorphisms were found in the promoter region and in intron 1 close to the 3' mRNA splice acceptor site. However, the allele frequencies of these polymorphisms in samples of individuals affected with either schizophrenia (n=117) or bipolar disorder (n=124) did not differ from those of control subjects (n=234), suggesting that these variations do not confer a predisposition to either of the functional psychoses.     

Comparison of three cardioverter defibrillator implantation techniques: initial results with transvenous pectoral implantation

A total of 121 patients underwent epicardial (n = 32), transvenous abdominal (n = 30), and transvenous pectoral (n = 59) ICD implants. Perioperative complications were defined as those occurring within 30 days after surgery. Hospital costs were calculated with $750 per day as a fixed charge. Duration of surgery was the time between the first skin incision and the last skin suture. Severe perioperative complications that were life-threatening or required surgical intervention occurred in the epicardial (6%) and transvenous (10%) abdominal groups, but not in the pectoral group. Perioperative mortality occurred only in the epicardial abdominal group, predominantly in patients with concomitant surgery (18%), and in 5% of patients without concomitant surgery. The duration of surgery was significantly shorter for transvenous pectoral implantation (58 +/- 15 min, P < 0.05) compared to transvenous abdominal implantation (115 +/- 38 min). Epicardial abdominal ICD implantation had the longest procedure time (154 +/- 31 min). The postimplant hospital length of stay was significantly shorter for pectoral implantation (5 +/- 3 days, P < 0.05) compared to transvenous (13 +/- 5) and epicardial (19 +/- 5) abdominal implantation. Total hospitalization costs significantly decreased in the pectoral implantation group ($4,068 +/- $2,099 for the pectoral group vs $14,887 +/- $4,415 and $9,975 +/- $3,657 for the epicardial and the transvenous abdominal group, respectively, P < 0.05). These initial results demonstrate the advantage of transvenous pectoral ICD implantation in terms of perioperative complications, procedure time, hospital length of stay, and hospitalization costs.     

Secondary ambulatory voice prosthesis implantation with the argon laser using local anesthesia

An alternative technique for secondary tracheo-esophageal puncture and voice prosthesis implantation in topical anesthesia on an outpatient basis was developed. With argon laser beam passed through a glass fibre in the instrument channel of a flexible endoscope a secondary puncture of the tracheo-esophageal wall is obtained. A voice prosthesis is fitted subsequently, so that the whole operation is performed in one session in about 30 minutes. We generally administer 7.5 mg Midazolam orally for light sedation; antibiotics are not required. This method expands the possibility of voice prosthesis fitting in patients who are not considered or willing to have general anesthesia for various reasons. In 33 cases we did not see any complication. In two cases the tracheal wall was too tight due to radiation therapy, so that an operation had to be performed later on in general anesthesia. In one case technical problems led to an operation in local anesthesia in two steps. In all cases the patients did not complain of any considerable discomfort.     

Assisted conception: current techniques and outcome

PURPOSE: To determine whether ingestion of a tooth whitener containing 6% hydrogen peroxide as bleaching agent affected the gastric mucosa of adult, female laboratory rats. MATERIALS AND METHODS: Thirty-six fasting rats were intubated with a single bolus (5 g/kg body weight) of the tooth whitener Natural White which contains 6% hydrogen peroxide. Thirty-two control rats received deionized water. Rats were necropsied 15 minutes, 2 hours, 1 and 2 weeks after whitener ingestion. The gastric mucosa was examined histologically and blood hematocrit, glucose, BUN, and bilirubin measured. RESULTS: Six of the 36 rats died within 2 hours of receiving whitener. Within 15 minutes of whitener ingestion, stomachs were grossly bloated with gas. Histological observation showed that gastric mucosal cells were vacuolated and gastric glands dilated. After 2 hours, gastric epithelial and glandular cells had sloughed off into the gastric lumen. Mean blood glucose and hematocrit were significantly (P < 0.05) elevated (233 +/- 41 mg/ml and 50.5 +/- 0.9%) over mean control values (129 +/- 8 mg/ml and 42.8 +/- 2.4%). Within 1 week, the stomachs of experimental rats were no longer bloated, the gastric mucosa appeared normal histologically, but mean blood hematocrit was significantly (P < 0.05) decreased (38.0 +/- 1.5%) from mean control value (43.3 +/- 0.5%). There were no significant differences in mean blood values 2 weeks after whitener ingestion.     

Implant placement: surgical techniques and considerations

Successful implant surgery largely depends on good planning and meticulous technique. The former requires an appreciation of the restorative requirements and visualization of the desired end result. This may be easier for the clinician who is delivering both aspects of treatment, but in other circumstances requires close collaboration between prosthodontist and surgeon. This paper focuses on the surgical techniques involved in implant surgery, because successful osseointegration is achievable only with careful surgical preparation.     

Mid-term surgical results after valve replacement with the CarboMedics valve prosthesis

Located at the level of the Z-line, the transverse cytoskeletal network of insect-flight muscle interconnects adjacent myofibrils with one another, and interconnects peripheral myofibrils with the cell membrane. This network has been presumed to keep myofibrils in register, or to distribute tension laterally among myofibrils. In this study, we used scanning-electron microscopy to reveal details of the three-dimensional arrangement of this network. The network is seen to interconnect longitudinal elements of the cytoskeletal network which surround each myofibril. The arrangement is not unlike that seen in vertebrate skeletal muscle. Interestingly, the transverse network makes contact with cell components such as dense bodies and mitochondria. Such contacts imply potential roles over and above those noted above. The network may be involved not only in mechanical function, but possibly also in intracellular communication.     

Combined surgical treatment with prosthesis of recurrent ventral and inguinal hernias

The presence of associated incisional and groin hernias is relatively rare and it represents an important problem in surgical treatment. The authors here report their experience of three patients treated with no reabsorbable prostheses placed according to Rives' technique for incisional hernias, and according to Stoppa's for inguinal hernias.     

Urethrography and cavernosography imaging in a small series of penile fractures: a comparison with surgical findings

OBJECTIVES: To compare our results of preoperative corporal cavernosography and retrograde urethrography in penile fractures with the clinical and intraoperative findings. METHODS: From January to October 1996, 7 cases of penile fracture were diagnosed at our inner city trauma center. All cases were associated with sexual activity and patients underwent preoperative retrograde urethrography and corpus cavernosography with immediate surgical intervention. RESULTS: We found that 2 patients who presented with blood at the meatus had intact urethras, whereas 2 of the 3 patients who had urethral lacerations did not have a bloody meatus. In 2 cases the urethrogram and cavernosogram revealed lacerations that were not initially detected surgically. However, in another 2 cases, the urethrogram and cavernosogram were falsely negative. Two of the seven corporal fractures were bilateral and five were unilateral. CONCLUSIONS: On the basis of this small sample, it appears that preoperative cavernosography and retrograde urethrography may show additional sites of tears in the corpora and urethra because hematoma formation may mask some ruptures. However, the presence or absence of a bloody meatus may not necessarily correlate with the status of the urethra, and the urologist also should be wary of a false-negative imaging study. We suggest that all cases of penile fracture be explored surgically, but preferably by a subcoronal degloving incision that allows careful examination of the urethra and corpora. Results of a larger series may determine if the routine use of these imaging modalities is justified intraoperatively.     

Placental implantation on the amniotic sheet: effect on pregnancy outcome

PURPOSE: To assess pregnancy outcome in patients with amniotic sheets and to determine whether outcome is affected by placental implantation on the amniotic sheet. MATERIALS AND METHODS: Sonograms obtained during the 2nd and 3rd trimesters were reviewed in 157 patients with amniotic sheets to confirm the presence of an amniotic sheet and to determine the relationship of the placenta to the amniotic sheet. The cesarean section rate, gestational age at birth, birth weight, birth weight percentile, and Apgar score 1 minute after birth were recorded in patients in whom the postnatal follow-up data were available. Data were compared with overall data obtained at the authors' institution during the same period. RESULTS: The placenta appeared implanted on the amniotic sheet in 41 (26.1%) of the 157 patients. In the 120 patients with amniotic sheets and follow-up data, the cesarean section rate was 32.5% compared with 21.5% overall. The mean gestational age at birth was slightly lower than that overall (38.2 vs 39.0 weeks, P < .001), but the birth weight percentile was similar (48.6% vs 50.0%, P = .58). No statistically significant differences were found in postnatal follow-up data between pregnancies with placental implantation on and in those without implantation on the amniotic sheet. CONCLUSION: Pregnancy outcome is similar in patients with and in those without placental implantation on the amniotic sheet.     

Patenting medical and surgical techniques: an ethical-legal analysis

Considerable controversy has recently arisen regarding the patenting of medical and surgical processes in the United States. One such patent, viz. for a "chevron" incision used in ophthalmologic surgery, has especially occasioned heated response including a major, condemnatory ethics policy statement from the American Medical Association as well as federal legislation denying patent protection for most uses of a patented medical or surgical procedure. This article identifies and discusses the major legal, ethical and public policy considerations offered by proponents and opponents of such patents. The existing literature divides up into those who favor such patents essentially without qualification, and those who condemn and wish to outlaw them. We advance a compromise position where administrative and legislative action is called for to provide more specific guidelines regarding the patentability of such processes by the Patent and Trademark Office. Our position, in sum, will be that too much is at stake in this complicated area for either the blanket prohibition, or wholesale, uncritical acceptance, of the patenting of medical and surgical processes or techniques.     

Inguinal lymphadenectomy in cancer of the penis: surgical techniques and indications

Lymph node invasion is one of the major prognostic factors of cancer of the penis. However, as it is difficult to evaluate clinically and by means of complementary investigations, inguinal or even ilioinguinal lymph node dissection is still indicated. As this surgery carries a certain morbidity (necrosis of skin edges, infection, lymphorrhoea and subsequent lymphoedema), the indications are presented according to the presence or absence of palpable inguinal lymph nodes and the stage of the primary tumour. Various surgical techniques are proposed: Superficial and deep inguinal lymph node dissection in the case of mobile and palpable inguinal nodes, simplified and superficial inguinal lymph node dissection in the absence of palpable inguinal nodes and in the case of invasive primary tumour.     

Early cellular and humoral response after vascular prosthesis implantation in the arterial system]

The aim of the study was to determine the level of leukocytes activation after the implantation of vascular graft. As an experimental model we used 20 dogs. The aorto-iliac unilateral graft (dacron 6 mm) was implanted to all animals. The adhesion and migration of the leukocytes was estimated postoperatively by scintigraphy using Tc99 labeled leukocytes. The increased migration and adhesion was found in both proximal and distal anastomoses till the 30th postoperative day and it was more intensive in the distal anastomosis.     

The infection of the vascular prosthesis treated by the human cryopreserved allograft implantation: a case report

75 years old patient was admitted to the Department with infection of the previously implanted bifurcated aorto-bifemoral by-pass. Periprosthetic retroperitoneal abdominal abscess in the US--colour doppler examination was recognized. Unilateral femoral pulse was present--the patient after femoral amputation of the right leg. In the first step of the treatment, the drainage of the periprosthetic abscess was performed. Because of poor results of the local and pharmacological treatment and bleeding from the prosthesis, in the next step, human cryopreserved aorto--femoral allograft was implanted "in situ". Simultaneously, bifurcated prosthesis was evacuated. In the postoperative period, healing of the inquinal wounds was excellent. There were no problems connected with peripheral circulation. The patient was discharged from the hospital on the 24th post-operative day in the good local and general condition. Homograft is an efficient and promising alternative for the treatment of severe vascular prosthesis infections.