Biomedical subjects
T R Malloy
Publications and source records attributed to T R Malloy.
Laser treatment of bladder carcinoma and genital condylomata.
The lasers most amenable to urologic surgery are the CO2, argon, and neodymium:YAG lasers. An understanding of the characteristics of these lasers is essential to the choice of the proper laser for the individual urologic condition to be treated. The relative advantages and disadvantages of all modes of therapy for bladder carcinoma and condylomata are discussed.
Prostatic cancer after prostatectomy for benign disease.
Twenty of 391 newly diagnosed cases of prostatic cancer (5%) had a prior prostatectomy for benign disease. Digital rectal examination in 16 of 19 patients (84%) revealed a significant prostatic abnormality. Continued serial digital rectal examination should be performed routinely after prostatectomy for benign disease.
Reliability of AMS M700 inflatable penile prosthesis.
Two hundred ninety patients have been followed up for at least one year or longer after implantation of the AMS M700 inflatable penile prosthesis. One hundred twenty-seven males have been followed up for two years or longer. Eighty-six impotent men had a follow-up of eighteen months or longer. The remaining 77 patients were studied for at least twelve months or longer. There have been 3 mechanical failures of cylinders implanted secondary to nonabsorbable surgical sutures remaining from previous prosthetic surgery. There were no reservoir or pump malfunctions. Eight patients had a slow leak from the nonkinking tubing. Since a revision of the manufacturing process of the nonkinking tubing in September, 1983, there have been no further leaks. Life table analysis for survival in this group of patients showed a probability of survival at three years of 97.9 per cent. The satisfaction rate among patients is greater than 90 per cent.
Renal preservation utilizing neodymium:YAG laser.
Six patients with malignancies in a solitary kidney were treated with conservative renal parenchymal-sparing surgery utilizing the Neodymium Yttrium Aluminum Garnet (Nd:YAG) laser. Three patients had transitional cell carcinoma in an upper pole calyx of a solitary kidney. The transitional cell carcinoma was treated definitively by the Nd:YAG laser through a nephroscope prior to partial nephrectomy. The 3 patients have been followed up for twenty-eight, eighteen, and six months, respectively. None of the patients has shown evidence of recurrent cancer on follow-up retrograde ureterograms or on urine cytology obtained from the renal pelves. Three patients with renal cell carcinoma in a solitary kidney had the tumor surgically excised utilizing the Nd:YAG laser in conjunction with standard surgical techniques. All the patients were elderly with compromised renal vasculature that prevented bench surgery with autotransplantation or occlusion of the renal artery. At sixteen, fourteen, and three months, respectively, there is no evidence of recurrent cancer on CAT scans obtained on these patients.
Toward bloodless nephrotomy during Gil-Vernet pyelolithotomy.
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Stenting techniques.
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Urologic neodymium: YAG laser surgery.
The advantages of each of the laser types used in urologic surgery are discussed and evaluated. Use of the Nd:YAG laser in urologic surgery is a recent advancement.
Vesicovaginal fistula and its complications due to prolonged use of vaginal diaphragm.
The vaginal diaphragm is currently less popular than other contraceptive methods, such as the pill, IUDs or surgical sterilization. It is however, regarded as one of the safest methods of contraception available and complications of diaphragm use are rare. This report describes a case in which a vesicovaginal fistula and genitourinary tract infections complicated the use of this contraceptive method.
Erectile failure following pelvic trauma: a review of pathophysiology, evaluation, and management, with particular reference to the penile prosthesis.
Twenty-five inflatable and two semi-rigid rod type penile prostheses have been implanted in 27 patients with erectile failure following pelvic trauma. Reoperation was required in 13 patients in the inflatable prosthesis group but ultimate success and satisfaction were achieved in 92%. The etiology of erectile failure following various types of trauma is reviewed, as well as the approach to the evaluation of erectile failure in such a patient. Where etiology-specific corrective therapy is not possible, the penile prosthesis has proven to be an acceptable form of substitution therapy.
Scrotal and penile lymphedema: surgical considerations and management.
From 1971 to 1981, 6 patients with scrotal and penile lymphedema were treated with total excision of the scrotal and penile skin. Split thickness skin grafts were used to cover the penis and form a neoscrotum. Of the patients 2 men had primary idiopathic lymphedema, while 4 had secondary lymphedema resulting from foreign body injections or trauma with subsequent chronic infection. Surgical considerations using split thickness skin grafts versus posterior lateral scrotal skin flaps are compared.
Revised surgical technique to improve survival of penile cylinders for the inflatable penile prosthesis.
A revised surgical technique to implant the inflatable penile prosthesis cylinder into the corpora cavernosa was used in 85 men. The technique places the inlet tube to the cylinder at the distal edge of the incision in the tunica albuginea. All sutures used to reapproximate the tunica are placed proximally over the solid components of the cylinder, eliminating the chance of sutures eroding the inflatable portion. The patients were followed for 12 to 24 months and have had no cylinder malfunctions.
A comparison of morbidity following transrectal and transperineal prostatic needle biopsy.
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Surgical results with artificial urinary sphincter.
From June, 1974, until January, 1977, eleven AMS 721 genitourinary sphincters were installed in 9 men and 2 females. Long term success was achieved in 2 men. Failures were encountered in 9 patients (82 per cent) with urethral erosions (3 patients), infection (1 patient), and mechanical failure (5 patients) accounting for the complications necessitating prosthetic removal. From January, 1979, until May, 1981, 15 males had the revised AMS model AS 742 (b) or (c) sphincter installed. Long term continence was achieved in 9 patients (60 per cent). Urethral erosion in 4 patients (27 per cent) and infection of the prosthesis in 2 men (13 per cent) accounted for fathers. An improved surgical technique involving the installation of the device in a defunctionalized state with secondary activation is anticipated to improve future results.
Improved mechanical survival with revised model inflatable penile prosthesis using rear-tip extenders.
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Expansion without significant rigidity during nocturnal penile tumescence testing: a potential source of misinterpretation.
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Advanced peyronie's disease treated with the inflatable penile prosthesis.
Nineteen patients with significant advanced Peyronie's disease (that is severe angulation, erectile impotence and/or intractable pain) that had not responded to conservative medical therapy were treated surgically with insertion of the inflatable penile prosthesis. Of the patients 10 had correction of angulation and/or erectile impotence by instillation of the prosthesis alone and needed no additional operation, while 8 required incisions of the tunica albuginea distal to the plaques in addition to the prosthesis to correct the deformity. One patient required a monofilament knitted polypropylene velour graft to cover the defect in the tunica albuginea. Satisfactory results were obtained in 18 of 19 patients.
Urologic tumors presenting as neurosurgical masses.
Metastases from urologic neoplasms often occur to the central nervous system or surrounding bony structures. Usually these metastases are discovered after the primary tumor has been identified. However, these tumors may present primarily with only manifestations of their central nervous system metastases. Five cases of different urologic tumors presenting as neurosurgical masses are presented, along with a brief review of the pertinent literature.