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.

In an effort to test the efficacy of the carbon dioxide laser in urethral reconstruction, patch graft urethroplasty was carried out comparing laser repair to microsurgical repair. The male Sprague Dawley rat was used as the model. An oval defect was created in the ventral urethra in 65 animals and repaired with a full thickness preputial skin graft conventional microsurgical repair, laser assisted microsurgical repair, or laser repair with a protein solder. The success rate, defined as the number of animals surviving without complications at the end of 21 days, was 50, 20, and 65% respectively. In conclusion, laser assisted repair using the protein solder was significantly better than microsurgical repair (p less than 0.05).

Reconstruction of the rat urethra using the CO2 laser and a protein solder has dramatically decreased the postoperative fistula rate and decreased surgical time over conventional microsurgical reconstruction. Using the rat as a model, a partial transection of the ventral urethra was repaired in one of three ways in 39 animals: conventional microsuture repair, laser assisted microsuture repair and laser assisted microsuture repair with a protein solder. The success rate in each group was 50%, 58% and 90% respectively. Therefore, the laser repair is as efficacious as conventional microsuture repair. More importantly, laser with solder is significantly better than either the conventional method or laser alone.

For patients with Peyronie's disease requiring surgery, the authors' treatment is to excise the plaque and replace the diseased area of the tunica with a dermal graft. The goal of the surgery is to create a functional penis without prosthesis. For the first few months, sexual therapy and counseling are very important to help the patient and partner work together toward rehabilitation.

No AccessJournal of Urology1 Jun 1987Restoration of Erectile Function by Surgical Repair of Intracorporal Fibrosis Charles J. Devine, Alex E. Brezinski, Charles N. Burns, and David A. Gilbert Charles J. DevineCharles J. Devine More articles by this author , Alex E. BrezinskiAlex E. Brezinski More articles by this author , Charles N. BurnsCharles N. Burns More articles by this author , and David A. GilbertDavid A. Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)76137-XAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Restoration of Erectile Function by Surgical Repair of Intracorporal Fibrosis." The Journal of Urology, 137(6), p. 350A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 350A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Charles J. Devine More articles by this author Alex E. Brezinski More articles by this author Charles N. Burns More articles by this author David A. Gilbert More articles by this author Expand All Advertisement PDF DownloadLoading ...

No AccessJournal of Urology1 Jun 1987A Trial to Investigate the Efficacy of Intravenous Steroids During Hypospadias Surgery to Reduce Postoperative Edema Charles N. Burns, Gerald H. Jordan, Charles E. Horton, and Charles J. Devine Charles N. BurnsCharles N. Burns More articles by this author , Gerald H. JordanGerald H. Jordan More articles by this author , Charles E. HortonCharles E. Horton More articles by this author , and Charles J. DevineCharles J. Devine More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)76129-0AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "A Trial to Investigate the Efficacy of Intravenous Steroids During Hypospadias Surgery to Reduce Postoperative Edema." The Journal of Urology, 137(6), p. 348A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137 Issue 6 June 1987 Page: 348A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.Metrics Author Information Charles N. Burns More articles by this author Gerald H. Jordan More articles by this author Charles E. Horton More articles by this author Charles J. Devine More articles by this author Expand All Advertisement PDF downloadLoading ...

No AccessJournal of Urology1 Jun 1987A Comparative Trial of Hypospadias Dressings Gerald H. Jordan, Boyd H. Winslow, David A. Gilbert, Patrick C. Devine, Charles E. Horton, and Charles J. Devine Gerald H. JordanGerald H. Jordan More articles by this author , Boyd H. WinslowBoyd H. Winslow More articles by this author , David A. GilbertDavid A. Gilbert More articles by this author , Patrick C. DevinePatrick C. Devine More articles by this author , Charles E. HortonCharles E. Horton More articles by this author , and Charles J. DevineCharles J. Devine More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)76128-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "A Comparative Trial of Hypospadias Dressings." The Journal of Urology, 137(6), p. 348A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 348A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Gerald H. Jordan More articles by this author Boyd H. Winslow More articles by this author David A. Gilbert More articles by this author Patrick C. Devine More articles by this author Charles E. Horton More articles by this author Charles J. Devine More articles by this author Expand All Advertisement Loading ...

Three cases of the unusual entity, mullerian duct cyst, are presented. Each was managed differently, demonstrating that with appropriate patient selection either aspiration alone, aspiration and instillation of a sclerosing agent, or transurethral resection of bladder base to establish communication and cyst drainage are successful.

The repair of all hypospadias in one stage represents state of the art in virtually all instances. Implicit in the repair of hypospadias is the correction of chordee, the construction of the neourethra such that the meatus is located on the tip of the glans, and the creation of a penis which is cosmetically appropriate. Described in this paper are most of the currently employed methods utilized for the repair of hypospadias in a single stage. The techniques described herein, in skilled hands, yield good results in 85–90% of cases. Repairs of hypospadias which have been designed and which are recommended for “the occasional operator” have no place in today's surgical therapy.

Hypospadias repairs must encompass straightening of the penis and construction of the neourethra at the tip of the penis. In addition to an outline of preoperative and postoperative management, five techniques of single-stage surgical repair are discussed. All hypospadias defects can be repaired using one of these five basic procedures.

No AccessJournal of UrologyLetters to the Editor1 Sep 1984Re: Peyronie’s Disease and Erectile Failure, by P. Metz, J. Ebbehøj, A. Uhrenholdt and G. Wagner, J. Urol., 130: 1103-1104, 1983 Charles J. Devine Charles J. DevineCharles J. Devine More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)49743-6AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Re: Peyronie’s Disease and Erectile Failure, by P. Metz, J. Ebbehøj, A. Uhrenholdt and G. Wagner, J. Urol., 130: 1103-1104, 1983." The Journal of Urology, 132(3), p. 568 © 1984 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByLopez J and Jarow J (2018) Penile Vascular Evaluation of Men with Peyronie’s DiseaseJournal of Urology, VOL. 149, NO. 1, (53-55), Online publication date: 1-Jan-1993.Metz P (2018) Re: Evaluation of Erectile Dysfunction in Patients with Peyronie’S Disease, by J. F. Stecker, Jr. and C. J. Devine, Jr. J. Urol., 132: 680-681, 1984Journal of Urology, VOL. 134, NO. 5, (975-975), Online publication date: 1-Nov-1985. Volume 132Issue 3September 1984Page: 568 Advertisement Copyright & Permissions© 1984 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Charles J. Devine More articles by this author Expand All Advertisement PDF DownloadLoading ...

No AccessJournal of UrologyGuest Editorial1 Apr 1980Urethral Strictures Charles J. Devine, and Patrick C. Devine Charles J. DevineCharles J. Devine More articles by this author , and Patrick C. DevinePatrick C. Devine More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(17)55992-3AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Urethral Strictures." The Journal of Urology, 123(4), p. 506 © 1980 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited ByLenzi R, Barbagli G and Stomaci N (2018) One-Stage Skin Graft Urethroplasty in Anterior Middle Urethra: A New ProcedureJournal of Urology, VOL. 131, NO. 4, (660-663), Online publication date: 1-Apr-1984.Lenzi R, Barbagli G, Stomaci N and di Cello V (2018) Free Full Thickness Skin Graft Urethroplasty: Indications, Technique and ResultsJournal of Urology, VOL. 128, NO. 5, (938-942), Online publication date: 1-Nov-1982. Volume 123Issue 4April 1980Page: 506 Advertisement Copyright & Permissions© 1980 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Charles J. Devine More articles by this author Patrick C. Devine More articles by this author Expand All Advertisement Loading ...

Urethral fistula, the most common complication of urethroplasty, is discussed. There has been no classification for these disorders, and the plethora of reconstruction procedures available often leads to confusion. The classification presented here for acquired fistulas attempts to give direction in the selection of appropriate management in individual cases. Early, acute fistulas are managed conservatively. In the case of mature single fistulas, local tissue may be used for surgical repair. These are subdivided, depending on the size of the opening. Chronic, multiple, large lesions draining the urethra require tissue from a distance for repair. In severe surgical cripples, a total new urethral reconstruction will be required. A new technique to expose the urethra, allowing correction of urethral fistulas with stricture and diverticulum, is described.

We reviewed 14 patients with epispadias not associated with exstrophy of the bladder. Our plan of therapy is outlined. Urethroplasty procedures are similar to those used for repair of hypospadias. Chordee may be more difficult to correct in patients with epispadias and may require dermal grafts to correct the shortness of the corpora cavernosa. In these patients and in those with incontinence, we employ a multistaged procedure, constructing the penile urethra after the underlying defects have been corrected.

Norfolk, Va. From the Departments of Plastic Surgery and Urology of the Eastern Virginia Medical School.

Secondary reconstruction of anterior urethral injuries should be delayed for 6 to 12 weeks after injury. Traumatic strictures of the urethra are repaired by application of full-thickness skin grafts by either incision of the stricture and patch graft or by excision of the urethra and tube graft, depending on the density of the urethral scar or defect.