Patrick C. Devine

Utricular Configuration in Hypospadias and Intersex

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.

New concepts in phallic reconstruction.

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.

Free Full Thickness Skin Graft Urethroplasty

AbstractDuring 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.

Posterior urethral injuries associated with pelvic fractures

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.

Free full thickness skin graft urethroplasty: current technique.

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.

Surgical Correction of Urethral Prolapse

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.

Clitoromegaly and Megalourethra in Idiopathic Female Intersex

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.

Vascular distal ureteral obstruction.

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.

Serum Lactic Dehydrogenase in Acute Renal Infarction and Ischemia

LACTIC dehydrogenase is an enzyme that catalyzes the reversible conversion of pyruvic acid into lactic acid in the presence of the coenzyme dihydro-nicotinamide adenine dinucleotide (NAD.H2): This ...

Full thickness urethral patch grafts in male rats: an experimental model.

Abstract 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.