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Biomedical subjects

J J Mulcahy

Publications and source records attributed to J J Mulcahy.

At least 19 recordsLinked to original sources
PubMed2002

Management of Peyronie's disease with penile prostheses.

Peyronie's disease is a common malady affecting men mostly between the ages of 40 and 60. When penile curvature and erectile softening are present and the erectile dysfunction does not respond to Viagra a penile implant will strengthen and usually straighten the penis. If curvature persists after implant placement 'modeling' the erect penis will successfully achieve straightening in most patients. Plaque incision and grafting or a Nesbit procedure are rarely necessary to straighten the penis but will afford excellent results when employed. A thorough explanation of the pathogenesis of Peyronie's disease and effects of the disease and treatment on penile size will help avoid some of the disappointment seen when a shorter erection occurs.

Humans↗
PubMed2001

Report of the American Foundation for Urologic Disease (AFUD) Thought Leader Panel for evaluation and treatment of priapism.

PURPOSE: Patients with priapism often develop permanent erectile dysfunction and personal sexual distress. This report is intended to help educate the public by reviewing the varied definitions and classifications of priapism and limited literature reports of pathophysiology, diagnosis and treatment outcomes of priapism. The AUA priapism guidelines committee is responsible for creating consensus as to appropriate individual patient management of priapism by physicians. MATERIALS AND METHODS: A multidisciplinary panel, consisting of 19 thought leaders in priapism, was convened by the Sexual Function Health Council of the American Foundation for Urologic Disease to address pertinent issues concerning the role of the urologist, primary care providers and other health care professionals in the education of the public regarding management of men with priapism. The panel utilized a modified Delphi method and built upon the peer review literature on priapism. RESULTS: The Thought Leader Panel recommended adoption of the definition of priapism as a pathological condition of a penile erection that persists beyond or is unrelated to sexual stimulation. Priapism is stressed to be an important medical condition that requires evaluation and may require emergency management. The classification system is categorized into ischemic and non-ischemic priapism. Essential elements of the ischemic classification are the inclusion of: (i) clinical characteristics of pain and rigidity; (ii) diagnostic characteristics of absence of cavernosal arterial blood flow; (iii) pathophysiological characteristics of a closed compartment syndrome; (iv) a time limit of 4 h prior to emergent medical care; and (v) a description of the potential consequences of delayed treatment. Essential elements of the non-ischemic classification are the inclusion of: (i) clinical characteristics of absence of pain and presence of partial rigidity; (ii) diagnostic and pathophysiological characteristics of unregulated cavernosal arterial inflow; and (iii) the need for evaluation but emphasizing the lack of a medical emergency. The panel recommended adoption of a rational management algorithm for the assessment and treatment of priapism where the cornerstone of initial assessment includes a careful clinical history, a focused physical examination and selected laboratory and/or radiologic tests. The panel recommended that specific criteria and clinical profiles requiring specialist referral should be identified. The panel further recommended that patient (and partner) needs and education concerning priapism should be addressed prior to therapeutic intervention, however only in the case of chronic management or post acute presentation evaluation should this delay intervention. Treatment goals to be discussed include management of the priapism with concomitant prevention of permanent and irreversible erectile dysfunction and associated psychosocial consequences. The panel recommended that when specific therapies for priapism are required, a step-care treatment approach based upon reversibility and invasiveness should be followed. CONCLUSIONS: The Thought Leader Panel calls for research to expand our understanding of the prevalence and diagnosis of priapism and education to create awareness among the public of the potential urgency of this condition. Critical areas to be addressed include the multiple pathophysiologies of priapism as well as multi-institutional trials to objectively assess safety and efficacy in the various treatment modalities.

Humans↗
PubMed2000

Use of the artificial urinary sphincter in women.

Persistent urinary incontinence after failed surgical repair can be successfully treated with the artificial urinary sphincter. The English literature was reviewed from 1985 to 1996. Eleven articles and abstracts addressing placement of the artificial urinary sphincter in women were identified. Discussion includes two operative techniques. Success rates were in the range of 91%-99%. Erosion rates were 7%-29%. The artificial urinary sphincter is an effective treatment for women failing other procedures. Appropriate work-up and diagnosis for type III stress urinary incontinence is crucial.

Female↗
PubMed2000

Surgical management of penile prosthesis complications.

Penile implants are mechanical devices used to treat erectile dysfunction. Parts of the implants may wear out with time, and the implants themselves may damage the body cavities in which they have been placed, especially with excessive or aggressive use. Techniques to replace parts, repair body cavities, and deal with infection associated with prosthesis placement have been developed. Satisfaction with the resulting erections is the highest among all the modalities available for treating erectile dysfunction. International Journal of Impotence Research (2000) 12, Suppl 4, S108-S111.

Equipment Failure↗
PubMed2000

Management of cuff erosion of the double cuff artificial urinary sphincter.

PURPOSE: We report on a series of patients with erosion of 1 cuff of an AMS800 double cuff artificial urinary sphincter and determine the success rate of removing the eroded cuff, leaving the other components behind and converting the device to a single cuff system. MATERIALS AND METHODS: In 9 patients with a double cuff artificial sphincter 1 eroded cuff was removed and the system was converted to a single cuff sphincter. RESULTS: Followup was based on an incontinence scoring system. In 1 patient the remaining cuff was removed because it also eroded. In another patient a wound infection developed 5 months after placement and the entire device was removed. The remaining 7 patients had better continence scores than before artificial sphincter placement but each remarked that continence was better with 2 cuffs. CONCLUSIONS: An eroded cuff of a double cuff artificial urinary sphincter system can be successfully removed and the device can be converted to a single cuff system.

Aged↗
PubMed2000

Long-term experience with salvage of infected penile implants.

PURPOSE: The effectiveness of treating patients with an infected penile implant by removing the device, cleansing the wound with a series of antiseptic solutions and placing a new device at the same procedure was assessed. MATERIALS AND METHODS: A total of 65 patients were included in the study. All foreign material was removed from the infected wound followed by copious wound irrigations with a protocol of 7 antibacterial solutions. A new prosthesis was inserted and the patient was placed on antibiotics. RESULTS: Followup ranged from 6 to 93 months. Recent status was determined in 85% of cases (55 of 65). Of the 55 patients 45 (82%) showed no sign of infection. In 5 patients recurrent infection was documented and in 5 others erosion of parts to the exterior possibly related to infection was noted. CONCLUSIONS: Salvage of an infected penile implant has been successful and is gaining in popularity among urologists to reduce morbidity associated with infection.

Clinical Protocols↗
PubMed2000

Erectile function after radical prostatectomy.

The early detection of prostate cancer through the use of prostate-specific antigen screening has resulted in the performance of many more radical prostatectomy procedures as a curative treatment for this disease. Many patients who are candidates for this procedure already suffer from erectile dysfunction, and the incidence of inadequate erections following radical prostatectomy is certainly high. Nerve-sparing procedures during performance of this operation are encouraged as the incidence of erectile dysfunction is lower if one or both nerves are spared. If the patient is already impotent before the procedure, medical treatments with oral agents, intraurethral compounds, or intracorporally injected medications may be more effective with the nerves intact. Early institution of medical therapy, specifically intracorporal injections, after 2 months postoperatively has resulted in a higher incidence of spontaneous return of erections at 1 year. Vacuum erection devices may be successful in restoring erections but extensive practice in their use is necessary, and they may be unappealing to many patients. A penile prosthesis will restore erections if the patient is so motivated for implantation of such a device. These are expensive and require invasive surgery, but satisfaction rates among patients and partners who have used them have been in the range of 85%, the highest satisfaction rate among all of the treatments of erectile dysfunction.

Age Factors↗
PubMed2000

Efficacy, safety and patient satisfaction outcomes of the AMS 700CX inflatable penile prosthesis: results of a long-term multicenter study. AMS 700CX Study Group.

PURPOSE: We performed a long-term multicenter study of the AMS 700CX 3-piece inflatable penile prosthesis, focusing on longevity, morbidity and patient satisfaction in men implanted up to 134 months with a median followup of 47.7 months. MATERIALS AND METHODS: We performed a large scale retrospective multicenter study in 2 phases. Phase 1 was a medical record review of 372 men who underwent implantation with the AMS 700CX penile prosthesis from 1987 to 1996 by 7 frequent penile prosthesis implanters. Phase 2 included a structured telephone interview of 207 patients by a neutral observer. RESULTS: For the 372 men in phase 1 mean device mechanical reliability plus or minus standard deviation was 92.1% + or - 3.3% after 3 and 86.2% + or - 4.6% after 5 years. Patient age was 21 to 79 years (mean 57.6 + or - 11.0) at implantation. The etiology of erectile dysfunction was vascular in 27.7% of the cases, Peyronie's disease in 16.9%, diabetes mellitus in 12.9% and radical surgery in 11.6%. Of the men 55.6% received previous treatment for erectile dysfunction. Postoperative infection and device malfunction developed in 3.2% and 17.5% of the cases, respectively. Of the 207 men interviewed in phase 2, 86% still had an AMS 700CX penile prosthesis implanted, including 87.1% with erection suitable for coitus. Currently 79% of those with a device use it at least twice monthly and 88.2% would recommend an implant to a relative or friend. CONCLUSIONS: The AMS 700CX penile implant produced suitable erection and excellent patient satisfaction at long-term followup in the majority of men. Implant reliability is excellent and postoperative morbidity is low.

Adult↗
PubMed1999

Distal corporoplasty for lateral extrusion of penile prosthesis cylinders.

PURPOSE: Lateral extrusion of a penile prosthesis cylinder is an uncommon but distressing problem. A technique is described to reseat the cylinder in a more medial and secure position under the glans penis by creating a new cavity for the cylinder behind the back wall of the fibrotic sheath containing it. MATERIALS AND METHODS: A total of 14 patients underwent corporoplasty using this technique with followup as long as 2 years. RESULTS: All patients had a satisfactory result with no recurrence of the original problem. CONCLUSION: This method which places the cylinder behind 2 secure layers is straightforward, simple and reliable.

Humans↗
PubMed1996

The prosthesis salvage operation: immediate replacement of the infected penile prosthesis.

PURPOSE: We describe our experience with salvage of the infected penile prosthesis at initial presentation in 11 patients. MATERIALS AND METHODS: All patients with prosthesis infection who presented since 1991 were considered for salvage surgery. Contraindications to a salvage operation included necrotic infections, diabetic patients with purulence in the corporeal bodies, rapidly developing infections and erosion of the device cylinders. RESULTS: In 1 patient in this group a salvage attempt was repeated after re-infection, for an overall success rate of 91%. Mean followup for the group was 21 months (range 9 to 42). Staphylococcus epidermidis was the infecting organism in 75% of our patients. CONCLUSIONS: Our experience demonstrates the safety and advantages of the immediate salvage technique.

Adult↗
PubMed1996

Long-term experience with the double-cuff AMS 800 artificial urinary sphincter.

OBJECTIVES: To assess the efficacy and safety of the double-cuff artificial urinary sphincter over a long-term period. METHODS: Ninety-five patients charts were reviewed from December 1986 to November 1995. Data on the degree of urinary incontinence and complications were compiled and tabulated. RESULTS: There were 10 cuff erosions (10.5%) and one infection (1.1%) requiring removal of the double-cuff system, with one death from unrelated causes. Two patients in the erosion group had a double-cuff system reinserted at a later date. Eighty-six patients have a double-cuff system, with 97.6% remaining dry. CONCLUSIONS: A tandemly placed double-cuff artificial urinary sphincter is safe and effective in the treatment of severe postprostatectomy urinary incontinence.

Equipment Design↗
PubMed1996

Penile curvatures and aneurysmal defects with the Ultrex penile prosthesis corrected with insertion of the AMS700CX.

PURPOSE: We reviewed our series of patients with an AMS700 Ultrex penile prosthesis whose erectile deformities were corrected by replacement with AMS700CX cylinders. MATERIALS AND METHODS: Ultrex cylinders were replaced by AMS700CX cylinders in 7 men with erectile deformities. RESULTS: Deformities were corrected successfully in all 7 patients. The penis is completely straight in 6 patients, while a mild 30-degree ventral curvature is present in 1. CONCLUSIONS: Erectile deformities with the AMS700 Ultrex penile prosthesis can be repaired successfully by replacement with the AMS700CX cylinders.

Adult↗
PubMed1996

Erosion rate of the double cuff AMS800 artificial urinary sphincter: long-term followup.

PURPOSE: We reviewed the erosion rate of the double cuff artificial urinary sphincter. MATERIALS AND METHODS: Charts of 95 patients were evaluated for erosions and underlying etiology. RESULTS: Ten patients had erosion of the cuffs, for an erosion rate of 10.5%. Of the 10 erosions 4 (40%) were secondary to iatrogenic injuries. CONCLUSIONS: Addition of a second cuff to the artificial urinary sphincter remains a safe alternative for patients with severe urinary stress incontinence.

Adolescent↗
PubMed1995

The effect of intracavernosal injection of papaverine hydrochloride on orgasm latency.

The research literature on the employment of various vasoactive drugs to induce penile erection has largely examined assessment and treatment techniques. One study specifically examined the duration of erection, or "orgasm latency," of the drug-induced erection. However, it did not determine the relation of this duration to pre-impotence duration. The intent of the present investigation was to make this determination. Subjects at a urology department impotence clinic were asked to estimate orgasm latency prior to impotence and with papaverine-induced erection. The mean orgasm latency prior to impotence was 9.9 minutes; with papaverine, 15 minutes. It is concluded that papaverine injection not only causes an erection but makes it last longer than naturally occurring erections.

Adult↗