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.

With the advent of modern tissue transfer techniques, most cases of urethral reconstruction can be approached with confidence that an excellent functional and cosmetic result is probable. The authors present a logical approach to urethral stricture disease predicated on the anatomy of the stricture disease. Only those procedures believed to offer a maximal chance of success are offered to the patients. Should a patient present with complex stricture disease, initially a flap procedure would be employed.

No AccessJournal of Urology1 Jun 1987The Dermal Graft Procedure for Peyronie’s Disease Surgery Gerald H. Jordan, Patrick C. Devine, Steven M. Schlossberg, David A. Gilbert, Charles E. Horton, and Charles J. Devine Gerald H. JordanGerald H. Jordan More articles by this author , Patrick C. DevinePatrick C. Devine More articles by this author , Steven M. SchlossbergSteven M. Schlossberg More articles by this author , David A. GilbertDavid A. Gilbert 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)75616-9AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "The Dermal Graft Procedure for Peyronie’s Disease Surgery." The Journal of Urology, 137(6), p. 220A © 1987 by The American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 137Issue 6June 1987Page: 220A Advertisement Copyright & Permissions© 1987 by The American Urological Association Education and Research, Inc.MetricsAuthor Information Gerald H. Jordan More articles by this author Patrick C. Devine More articles by this author Steven M. Schlossberg More articles by this author David A. Gilbert 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 ...

Over the past four years we have performed total phallic reconstructions in 12 patients. Six patients underwent reconstruction following trauma, 3 were female-to-male transsexuals, and 3 had micropenis deformities. These reconstructions were one-stage microsurgical tissue transfers that included urethral reconstruction and coaptation of erogenous nerves. The surgical indications, techniques, and results are discussed.

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 ...

We have successfully performed 10 patch graft urethroplasties in adult male rats utilizing non-hairbearing penile skin with microsurgical technique. This model allows us to study the histology of the full thickness patch graft and the effects of various irritants such as contrast material, genitourinary irrigant, urine, and lubricant. We will describe the surgical technique, and representative microsurgical sections of the neourethra will be presented.

The types of fracture of the bony pelvis are categorized, and a system for diagnosis and treatment is recommended which should prevent many strictures and make those which do develop, easier to repair secondarily. This system of treatment should reduce trauma to the nerves and blood vessels.

We describe and review the most recent techniques of male genital reconstruction, identifying relevant material with an unstructured PubMed-based search of previous reports, using the keywords ‘reconstruction’, ‘glans’, ‘shaft’, ‘lymphoedema’, ‘skin graft’, ‘scrotoplasty’, ‘urethroplasty’, and ‘penile prosthesis’. This search produced 22 reports that were analysed in this review. Split-thickness skin grafts are ideal for glans reconstruction, while full-thickness skin grafts should be used to cover defects on the shaft penis, as they tend to heal with less contracture. The radial artery-based free-flap phalloplasty is the technique of total phallic reconstruction associated with the highest satisfaction rates. Further research is required to identify an ideal reconstructive technique that would guarantee superior cosmetic and functional results, minimising donor site morbidity.

Idiopathic female intersex can present with a varying phenotypic expression but generally includes clitoromegaly in association with either urogenital and/or cloacal anomalies. Additionally, absence of corporeal bodies may exist, resulting in either a markedly enlarged empty phallus or a megalourethra if developmental anomalies of the urogenital sinus occur in association with corporeal agenesis. Herein we report 2 cases to illustrate the spectrum of this disorder.

To evaluate the incidence and significance of an enlarged prostatic utricle in hypospadiac patients without underlying intersex 44 patients with the meatus located in the perineum, penoscrotal junction or proximal two-thirds of the penis were evaluated with cystourethroscopy immediately before the operation. There was an abnormally enlarged utricle in 57 per cent of the perineal, 10 per cent of the penoscrotal and none of the penile hypospadias and intersex revealed a high incidence of enlarged utricle or the presence of a vagina masculinus. Utricular enlargement in itself doses not indicate intersexuality but careful cystoscopic examination of its vault needs to be undertaken, searching for a cervix. An enlarged utricle can be a manifestation of delayed mullerian duct regression or decreased androgenic stimulation of the urogenital sinus.

Since prolapse of the female urethra is the result of inadequate pelvic attachment we believe treatment should be reduction of the herniated urethra and fixation of the bladder and urethra to the posterior surface of the symphysis and rectus abdominis muscles.

We present details of our current techniques for skin graft urethroplasty. We believe that careful attention to the details of these operative techniques is important to their success. The changes from our previous reports include: 1) preparation of patch grafts with rounded ends, 2) preparation of tube grafts with fishmouth spatulation, 3) fixation of the stent catheter to the anterior abdominal wall, 4) leaving a stent catheter inlying for 2 weeks and replacing with a smaller catheter if a voiding cystourethrogram shows extravasation, 5) fixation of the graft during preparation by dermatome adhesive, 6) irrigation of the wound with irrigant before closure and 7) urodynamic flow study for non-invasive postoperative followup.

During the last 15 years we have repaired urethral strictures of each zone of the urethra using a free full thickness skin graft technique. We now report the details of our operative procedure and the results.

The diagnosis, treatment and results of 6 patients with 7 obstructed distal ureters secondary to vascular compression are presented. Three ureters were treated by transection of the offending vessels and the remaining 4 required additional ureteroneocystostomy.

A method of treatment of patients with vesicoureteral reflux which we have found successful involves careful classification by cause, severity, and course of the condition. Frequent periodic reevaluation is necessary to permit reassignment of the patient to another category of treatment when appropriate.