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Biomedical subjects

G H Jordan

Publications and source records attributed to G H Jordan.

At least 19 recordsLinked to original sources
PubMed1997

Laparoscopic pyelolithotomy.

Laparoscopic surgery has been applied to virtually every aspect of urinary tract disease. Presented is a case of laparoscopic-extended pyelolithotomy accomplished in a 16-month-old child with a large cystine stone that occupied the child's entire renal pelvis. Although not the first pyelolithotomy accomplished laparoscopically, we believe this to be the first extended laparoscopic pyelolithotomy and also believe this is the youngest patient in whom laparoscopic pyelolithotomy has been done. Extracorporeal shock wave lithotripsy and percutaneous and endoscopic stone techniques have drastically modified the management of urolithiasis. However, select cases in which these techniques may not be applicable (such as this toddler with bulky cystine lithiasis) may require open surgery. The laparoscopic approach represents an excellent, yet less-invasive option.

Female↗
PubMed1996

The role of colpocleisis with urethral lengthening in transsexual phalloplasty.

OBJECTIVE: Transsexual surgery is an unique area of rarely performed surgery. This study examines factors that have significance in the prevention of major morbidity in this unusual surgery. The role of the gynecologist in the psychologic, endocrine, and operative management is presented. STUDY DESIGN: Initial operations were complicated by fistulas at the urethra-to-phallus anastomosis site. After reviewing these complications, we modified our approach to include a two-stage procedure allowing for healing before microsurgery and sparing of the anterior vaginal wall during vaginal hysterectomy and colpocleisis. By sparing the anterior vaginal wall, we were able to better extend the urethra for later phallus attachment. RESULTS: Using the two-stage procedure at colpocleisis allowed a significant reduction in the fistula rate. (p = 0.0087) with the effective elimination-fistulas, the use of stiffeners during phalloplasty for better functional results is possible. CONCLUSION: Extending the urethra during colpocleisis allows for better healing and significantly decreased fistula formation. Proper blood supply for microvascular surgery and adequate tissue for the anastomosis site contribute to better results.

Female↗
PubMed1994

Laparoscopic single stage and staged orchiopexy.

The initial series of laparoscopic single stage orchiopexy for the abdominal or emergent impalpable undescended testis is reported. The first laparoscopic orchiopexy was performed at our institution in October 1991. Between October 1991 and January 1993, 14 patients (16 testes) underwent minimally invasive surgery with 6 months of followup in all cases. No evidence of testicular loss or acute atrophy has occurred, with the entire procedure being accomplished by laparo-endoscopic techniques in all cases. Treatment of 3 of the 16 testicles consisted of stage 2 of staged orchiopexy, and to our knowledge these cases represent the first stage 2 orchiopexy completed by laparoscopic techniques. In those cases stage 1 was performed by laparoscopic clipping of the vessels. The details of the procedure as we now perform it are described.

Adolescent↗
PubMed1994

Penile prosthesis implantation in total phalloplasty.

A series is presented of 8 patients who had undergone either total phalloplasty or free flap penile reconstruction. Our experience with prosthetic implantation is reviewed as is a brief history of phallic construction, including previously reported efforts at achieving rigidity with prosthetic implantation, autologous material implantation and so forth. We present in detail our current technique of implantation in these 8 patients, who underwent 10 attempts at implantation. In 4 patients infection necessitated removal of the prosthesis (2 have since undergone successful reimplantation). Of the 8 patients in whom implantation was attempted 6 (60%) currently have prostheses in place.

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

Laparoendoscopic upper pole partial nephrectomy with ureterectomy.

A 14-year-old white girl presented with a history of recurrent urinary tract infections beginning at age 18 months. Anatomical evaluation revealed bilateral duplication of the collecting systems. On the right side of the upper pole moiety ended at an obstructing orthotopic ureterocele. On the left side the upper pole moiety was associated with an ectopic ureteral orifice. The patient underwent laparoendoscopic right upper pole partial nephrectomy with ureterectomy. To our knowledge this is the first report of a laparoendoscopic upper pole partial nephrectomy. Details of the procedure are discussed.

Adolescent↗
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

Repair of the complications of hypospadias surgery.

In 1992 a retrospective review was conducted of 190 patients evaluated and treated for complications of hypospadias surgery during 1979 through 1990 at the Devine Center for Genitourinary Reconstructive Surgery of Sentara Norfolk General Hospital and Children's Hospital of the King's Daughters. We could not contact 13 patients and 8 are awaiting a second stage procedure. Of the 177 patients 167 (94.35%) have had a successful outcome, defined as a controllable urinary stream, functional erection and an acceptable cosmetic appearance, and 2 (1.13%) are considered failures. Details of presenting problems, surgical techniques and recent modifications of these procedures are presented.

Adolescent↗
PubMed1993

Prepubertal vasal injury: its effect on postpubertal vas deferens.

At this institution, via clinical observation at laparoscopy, a phenomenon was noted in humans that was associated with injury to the prepubertal vas deferens. There were 4 cases that presented with apparent atrophy of the abdominal pelvic portion of the vas deferens following injury to the vas in the prepubertal period. A study was undertaken to see if this phenomenon could be duplicated in an animal model. Prepubertal Sprague-Dawley rats were selected and divided into several groups ranging from sham surgery to unilateral partial vasectomy. These groups allowed for observations following different modes of trauma as well as creation of a control population. Additionally, an adult group was studied to evaluate the effects of vas injury in the adult rat. In the adult group, following trauma to the vas, no changes in the abdominal pelvic portion of the vas were noted. In the prepubertal group, with ligation and with segmental excision (partial vasectomy), striking diminution in outer diameter and wall thickness of the distal vas deferens was noted. This study indicates that the rat prepubertal vas serves as a good model for study of the human vas deferens. Further studies are underway which seek to elicit the mechanism of the observed injury.

Animals↗
PubMed1993

Phallic construction in prepubertal and adolescent boys.

During the last 10 years we performed microsurgical phallic reconstruction in 7 prepubertal and 4 adolescent boys. Indications for surgery included post-traumatic amputation, circumcision accident, developmental anomalies and micropenis. In addition, we performed phalloplasty on 5 other patients 18 to 24 years old. Total phallic reconstruction consisted of 1-stage microsurgical tissue transfers that included urethral reconstruction, coaptation of erogenous nerves, aesthetic refinement and, in some cases, scrotal reconstruction. All postpubertal patients recovered erogenous sensibility in the reconstructed phallus and the ability to masturbate. Surgical indications, techniques and results are discussed.

Adolescent↗
PubMed1993

Laparoscopically assisted continent catheterizable cutaneous appendicovesicostomy.

Described is a case of laparoscopically assisted continent catheterizable cutaneous appendicovesicostomy in a 15-year-old female patient with bilateral ectopic ureteroceles and a totally obliterated bladder neck. The appendix and cecum were mobilized and dissected entirely via laparoendoscopic techniques. The nonrefluxing appendiconeocystostomy required an open cystotomy. The surgical technique and perioperative course are described.

Adolescent↗
PubMed1992

Microsurgical forearm "cricket bat-transformer" phalloplasty.

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.

Adult↗
PubMed1992

Premalignant lesions and nonsquamous malignancy of the penis and carcinoma of the scrotum.

Premalignant lesions of the penis include cutaneous horn, balanitis xerotica obliterans, and leukoplakia. The true incidence of progression of each of these to squamous-cell carcinoma is unknown. Bowenoid papulosis, erythroplasia of Queyrat, and Bowen's disease are histologically identical to in situ carcinoma. Although the first is consistently benign, the latter two regularly evolve into invasive cancer. Malignant scrotal lesions include squamous-cell carcinoma, liposarcoma, leiomyosarcoma, basal-cell carcinoma, extramammary Paget's disease, erythroplasia of Queyrat, malignant melanoma, and metastases. Hemangioma can be confused with carcinoma.

Carcinoma↗