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Biomedical subjects

W L Furlow

Publications and source records attributed to W L Furlow.

At least 19 recordsLinked to original sources
PubMed1996

A randomized crossover study using yohimbine and isoxsuprine versus pentoxifylline in the management of vasculogenic impotence.

PURPOSE: We evaluated the efficacy and safety of yohimbine and isoxsuprine or pentoxifylline in the management of vasculogenic erectile dysfunction. MATERIALS AND METHODS: A total of 20 patients diagnosed with arterial insufficiency and cavernous venous leakage by pharmacological penile duplex scanning underwent nonhormonal oral therapy. A randomized crossover study was performed using 5.4 mg. yohimbine plus 10 mg. isoxsuprine or 400 mg. pentoxifylline 3 times daily. Response to therapy was assessed by a sexual questionnaire and repeat penile duplex ultrasonography. RESULTS: No patient in either phase of the study in either group had a complete response to the oral regimen(s) and there was no improvement in the pre-injection or post-injection cavernous arterial peak systolic flow velocities or resistance indexes. CONCLUSIONS: Our study suggests that these oral agents, although well tolerated, were not effective in the management of these patients with mixed vasculogenic erectile dysfunction.

Administration, Oral↗
PubMed1996

Treatment of penile fibrosis with prosthetic implantation and flap advancement with tissue debulking.

PURPOSE: Even after successful penile prosthesis implantation in patients with extensive penile fibrosis, a subset will have insufficient penile length for satisfactory sexual intercourse. We report a combined surgical approach to gain additional functional length in these patients. MATERIALS AND METHODS: During the last 18 months 11 patients with extensive cavernous fibrosis underwent penile prosthesis implantation with a modified suprapubic V-Y advancement flap and lower abdominal tissue debulking. RESULTS: After prosthesis implantation the accompanying procedures allowed these patients to gain an additional 3.5 to 6.5 cm. in functional length. All patients had a functional device after a mean followup of 12 months. No prosthesis became infected and no patient required an additional flap procedure. CONCLUSIONS: This surgical approach allows patients to gain additional functional length for satisfactory intercourse after treatment of extensive penile fibrosis.

Aged↗
PubMed1995

Management of nondilatable cavernous fibrosis with the use of a downsized inflatable penile prosthesis.

The basic underlying cause of inability to implant a penile prosthesis is cavernous fibrosis resulting in unsatisfactory cavernous dilation. During the last 3 years, 20 patients with severe cavernous fibrosis underwent penile prosthetic implantation with a downsized inflatable penile prosthesis, obviating the need for additional cavernous reconstruction. After a mean followup of 20 months 19 of the 20 patients had a functional device with only 1 requiring explantation for infection. We believe that this downsized penile prosthesis is a valuable addition to the urological armamentarium when considering reimplantation or implantation in a patient with intracavernous fibrosis and scarring.

Adult↗
PubMed1994

Inflatable cavernosal body device: feasibility and acute safety study in the canine model.

OBJECTIVES: To determine the feasibility, safety, and acute mechanical reliability of a two-piece, implantable, inflatable cavernosal body compression device in the canine model. METHODS: Six large male dogs underwent implantation of an inflatable cavernosal compression device consisting of an inflatable cuff and a pump reservoir. The device was implanted around the corpora cavernosa excluding the corpus spongiosum near the crura. RESULTS: All devices were cycled three times a week for 2 months and radiographic evaluation found them to be mechanically reliable. Infusion cavernosometry with inflation of the device demonstrated greater than a 100% increase of intracorporeal pressure from baseline levels. Histologic assessment showed no adverse tissue effects on the penile tissue underlying the cuff or remote from the cuff in the penis and there was no development of distant thromboembolism. CONCLUSIONS: The results from this study will form the basis of long-term canine studies to investigate physiologic changes on the canine erection and chronic safety and reliability of the device.

Animals↗
PubMed1992

Penile venous ligation surgery for the management of cavernosal venous leakage.

Forty-one patients underwent penile venous ligation surgery for pure cavernosal venous leakage diagnosed by infusion cavernosometry and cavernosography. Before surgery, arterial integrity was assessed by pelvic angiography, and all patients were found to have a normal penile arterial system. The patients were divided into two groups on the basis of the type of venous operation performed. The overall complete-potency success rate was 46% (19 of 41 patients). Postoperative complications were minimal. Our experience shows that penile venous surgery remains an acceptable option for treatment of carefully selected patients with documented pure cavernosal venous leakage of a mild degree who have no evidence of arterial insufficiency and who do not prefer, or are not suitable for, other medical or surgical treatment options. Patients who had more severe degrees of cavernosal venous leakage had a poor result from this procedure. For patients with moderate to severe venous leakage, we now perform a combined surgical procedure, deep dorsal vein arterialization and venous ligation.

Adult↗
PubMed1992

Corporeal reconstruction and prosthetic implantation for impotence associated with non-dilatable corporeal cavernosal fibrosis.

Thirty patients with severe cavernosal body fibrosis, secondary to various etiologies, underwent penile prosthetic implantation with cavernosal reconstruction using Gortex grafting material. The overall success rate was 70% (21 of 30 patients). Infection was the most significant postoperative complication and required device removal in 9 patients. This operative procedure was the only option these patients had in hope of restoration of erectile function for satisfactory sexual intercourse. We continue to recommend this procedure to the highly motivated, carefully selected patient.

Adult↗
PubMed1990

Clinical experience implanting an inflatable penile prosthesis with controlled-expansion cylinder.

Ninety-four patients with erectile dysfunction underwent implantation of controlled-expansion inflatable penile prosthetic cylinders. Most of these patients had aneurysmal dilatation of the corpora cavernosa after prior implantation of inflatable devices. Follow-up of forty-six months has shown their efficacy to be excellent for management of primary impotence, penile straightening procedures, and revision after cylinder leaks. None of the patients has had recurrence of the primary condition that required revision.

Adult↗
PubMed1990

Management of Peyronie disease by implantation of inflatable penile prosthesis.

Sixty-seven patients with advanced Peyronie disease were treated by implantation of an inflatable penile prosthesis (IPP). Twenty-eight of the 67 patients had documented total erectile failure. The remaining 39 patients had significant penile curvature causing "mechanical impotence" due to inability to achieve adequate vaginal penetration and chose implantation of an inflatable penile prosthesis (in some cases, combined with a straightening procedure) rather than one of the standard penile straightening procedures. Currently, 63 of the 67 patients have functioning prosthetic devices; in 3 other patients the device was removed because of infection, and 1 patient was dissatisfied and had the device removed. For impotent patients with severe Peyronie disease for whom other medical or surgical treatment is neither desirable nor suitable, we recommend implantation of an inflatable penile prosthesis combined with a possible straightening procedure.

Adult↗
PubMed1989

Pericatheter retrograde urethrography: introduction of a new device and technique.

We describe a new device and technique that allowed for radiographic evaluation of anastomoses before removal of the catheter in 80 patients who had undergone either radical retropubic prostatectomy or urethroplasty. Of these patients 11 showed significant extravasation and required continued catheterization. We advocate this procedure for documentation of complete urethral healing to prevent premature catheter removal.

Adult↗
PubMed1989

Clinical experience with controlled expansion cylinders. The AMS 700 CX inflatable penile prosthesis.

Device manufacturers continue to look for modifications in design to achieve specific objectives directed at improving overall reliability. Changes in design that do not address this extremely significant concern, namely, device reliability, fail in their commitment toward improvement in patient satisfaction. One of the most effective ways to assess the benefits provided by any change in device design is through the clinical trial and study group method, utilizing a large number of implanting surgeons from a variety of backgrounds and with a variety of patients. The results of the clinical trials with the AMS 700 CX cylinders were extremely encouraging. More importantly, the findings of the study group and our own findings have been substantiated through widespread clinical application among an even larger number of implanting physicians. Device reliability should continue to be under serious scrutiny. We, as implanting physicians, are constantly being asked by our patients, "How long can I expect this device to function?" The answer can only be given on the basis of reports such as this and others that address the results of implantation in a series of patients who are followed appropriately year after year. Each year these reports, if brought up to date, will become even more meaningful. Meanwhile, new designs continue to be evaluated in the laboratory and will become a reality only through the suggestions provided by implanting surgeons, whose observations, when relayed to the manufacturer, enable the design engineer to address the specific concerns of both patient and physician. The AMS 700 CX inflatable penile prosthesis with its new controlled expansion cylinders has certainly addressed those concerns for the present.

Humans↗
PubMed1988

Implantation of model AMS 700 penile prosthesis: long-term results.

The American Medical Systems inflatable penile prosthesis has undergone periodic design changes to improve device reliability and longevity while maintaining a high degree of patient and partner satisfaction. Previous data reported from this institution did not consider these frequent design changes and the assessment of device reliability incorporated consecutive cases involving several different designs. This study was designed to evaluate followup data on 120 patients who received the model 700 inflatable penile prosthesis, permitting assessment of device reliability of a single design. Two groups were evaluated: a pre-fix group of 57 patients and a post-fix group of 63 patients. Over-all, 11.7 per cent of the total group required revision (21 per cent of the pre-fix and 3.2 per cent of the post-fix groups). Careful life-table analysis of the results with the current model 700 device (post-fix) reveals that this model has a 97 per cent chance of maintaining normal mechanical function for 3 years. Further assessment of these patients in the future will provide additional data on long-term reliability of this design.

Erectile Dysfunction↗
PubMed1988

The inflatable penile prosthesis: clinical experience with a new controlled expansion cylinder.

Controlled expansion inflatable penile prosthetic cylinders were implanted in 63 patients with erectile dysfunction from September 1983 through January 1986. The majority of these patients previously had received standard inflatable cylinders. To study the efficacy of these new cylinders, revision with the controlled expansion cylinder was used in various conditions, with aneurysmal dilatation of the corpora cavernosa being the most common cause for cylinder replacement. Controlled expansion cylinders were used for revision after cylinder leaks and for penile straightening procedures as well as in the primary treatment of impotence. During our 3-year followup of these patients there have been no recurrences of the primary problem that necessitated the revision.

Adult↗
PubMed1987

Salvage of the eroded inflatable penile prosthesis: a new concept.

Most surgeons consider erosion of any component of an inflatable penile prosthesis as an indication for total device removal. However, it has been our contention that in selected cases conservative management can be used and the device can be salvaged. In 32 patients with erosion of various device components we performed conservative salvage techniques, consisting of immediate component replacement, repositioning of the eroded component or removal of only the eroded component in conjunction with closed drainage and antibiotic irrigation. Early success with device salvage resulted in the development of a rigid protocol for patient selection and management. Salvage techniques were successful in 16 of 22 cases of scrotal pump erosion and in all 8 cases of reservoir erosion. In 2 cases of cylinder erosion salvage attempts failed.

Adult↗
PubMed1987

Urodynamic evaluation of patients after the Camey operation.

Ten patients were evaluated urodynamically 3 to 18 months after they underwent the Camey operation. Of these patients 2 had total diurnal and nocturnal continence, 1 was totally incontinent and 6 were incontinent to various degrees that necessitated the use of 1 to 3 pads or diapers per day. All but 2 of the Camey neobladders had cystoplasty contractions at a capacity of 50 to 200 ml. The 2 totally continent patients had no cystoplasty contractions. The bladder in the totally incontinent patient had good capacity, good compliance and low pressure contractions up to a volume of 400 ml. The condition in this patient may be attributed to sphincteric incontinence. Urinary flow is achieved by abdominal straining and is interrupted. Vesicoureteral reflux occurred in 3 of 20 renal units.

Aged↗
PubMed1987

Use of a balanced bowel preparation solution in urological surgery.

A balanced bowel preparation solution was used in 25 patients undergoing cystectomy and in 31 undergoing radical retropubic prostatectomy. No significant problems occurred during the preparation, intraoperatively or postoperatively. Metronidazole and neomycin were used for antibiotic coverage. Consistent with the findings of other studies no significant physiological shifts occurred and patient acceptance was good. Savings were noted in cost, duration of hospitalization, time needed for nursing care and nutritional status. The balanced bowel preparation solution is an attractive and equally effective alternative to the standard laxative-enema bowel preparations for urological operations.

Electrolytes↗
PubMed1987

The model AS 800 artificial urinary sphincter: Mayo Clinic experience.

The model AS 800 artificial urinary sphincter was implanted in 100 male and 9 female patients between 7 and 89 years old. Postoperative followup was 1 to 32 months. The indication for implantation was total urinary incontinence in 86 patients (78.9 per cent), stress incontinence in 22 (21.2 per cent) and urgency incontinence in 1 (0.9 per cent). Of the patients 97 (89 per cent) underwent implantation for the first time, 7 (6.4 per cent) had a previous artificial urinary sphincter model replaced by the AS 800 device and 5 (4.6 per cent) underwent reimplantation of a previous model. The cuff was placed around the bladder neck in all 9 female patients, whereas in the male patients the cuff was implanted around the bladder neck in 20 and around the bulbous urethra in 80. Thirty-one patients (28.4 per cent), 29 of whom were continent at night, were practicing nocturnal deactivation of the device. Complete post-activation continence was achieved in 91 patients (83.5 per cent), some leakage occurred in 10 (9.2 per cent) and 8 (7.3 per cent) remained incontinent. A total of 23 patients required 1 or more revisions, the most common indications for the first revision being loss of cuff compression (9), tubing kink (3), cuff erosion (3) and infection (2). At the time of this report 89 patients (81.7 per cent) were continent, 9 (8.3 per cent) still had some leakage, 3 (2.8 per cent) were incontinent, 5 (4.6 per cent) were awaiting reimplantation and 3 (2.8 per cent) had died of unrelated causes.

Adolescent↗