Cutaneous temperature measurements in men with penile prostheses: a comparison study.

To evaluate and compare the cutaneous temperature of the penis in normal men, those with erectile dysfunction (ED), those with semirigid penile prostheses (SRPPs), and those with inflatable penile prostheses (IPPs), and those before and after trimix injection to create a penile erection. A total of 68 patients were evaluated. Five patient groups were identified, including men with normal erectile function, with ED, with SRPPs, with IPPs, and following intracavernosal injection of trimix solution. Cutaneous glans temperature increased significantly by more than 2.2 degrees C in the trimix-injected group compared with all other groups (P<0.001). Using cutaneous temperature measurements of the penis, patients with SRPPs had significantly lower cutaneous glans temperatures than normals (P<0.02), those in the ED group (P<0.04), and those in the IPP-deflated group (P<0.01). The mean temperature difference was 1.44+/-0.40 degrees C. Using cutaneous temperature measurements of the penis, men with SRPPs have a colder glans as compared with men with normal erectile function, ED, IPPs, and those who have received an injection of trimix. Men with normal erectile function, ED, and IPPs did not have significant cutaneous temperature differences.

Effects of age, menopause, and comorbidities on neurological function of the female genitalia.

The aim of this study was to investigate the effects of age, menopause, and comorbidities on neurological function of the female genitalia using a noninvasive, validated technique. In all, 58 consecutive women were enrolled in the study. Biothesiometry was performed at five genital sites and one peripheral site with S2 dermatome distribution. Kruskal-Wallis one-way ANOVA on ranks was used to evaluate the relationship between age and vibratory sensation. Bivariate and regressional analyses were performed to evaluate the effects of age, menopause and comorbidities on genital sensation. The mean age was 44.6+14.8 y (range 20-78 y). Vibration thresholds increased with advancing age at all six sites. Multilinear regression analysis indicated that menopause and increasing age negatively affect sensation. History of herniated lumbar disc, vaginal delivery, and diabetes variably affected genital sensation. There is a significant increase in vibration thresholds (indicating worsening neurological function) in women as they age and undergo menopause. Biothesiometry is a technique for evaluating genital neurological function in women with coexisting morbidities.

The neuropathy of erectile dysfunction.

These studies were intended to explore the relationship between autonomic neuropathy and erectile dysfunction (ED). Sensory thresholds reflecting the integrity of both large diameter, myelinated neurons (ie pressure, touch, vibration) and small diameter axons (ie hot and cold thermal sensation) were determined on the penis and finger. Data were compared across subjects with and without ED, controlling for age, hypertension and diabetes. The correlation of specific thresholds scores and IIEF values were also examined. Seventy-three patients who visited the academic urology clinics at Montefiore hospital were evaluated. All patients were required to complete the erectile function domain of the International Index of Erectile Function (IIEF) questionnaire: 20 subjects had no complaints of ED and scored within the 'normal' range on the IIEF. Patients were subsequently tested on their index finger and glans penis for vibration (Biothesiometer), pressure (Semmes-Weinstein monofilaments), spatial perception (Tactile Circumferential Discriminator), and warm and cold thermal thresholds (Physitemp NTE-2). Sensation of the glans penis, as defined by the examined sensory thresholds, was significantly diminished in patients with ED and these differences remained significant when controlling for age, diabetes and hypertension. In contrast, thresholds on the index finger were equivalent in the ED and non-ED groups. Threshold and IIEF scores were highly correlated, consistent with an association between diminished sensation and decreasing IIEF score (worse erectile functioning). These relations also remained significant when controlling for age, diabetes and hypertension. The findings demonstrate dysfunction of large and small diameter nerve fibers in patients with ED of all etiologies. Further, the neurophysiologic measures validate the use of the IIEF as an index of ED, as objective findings of sensory neuropathy were highly correlated with worse IIEF scores. The sensory threshold methods utilized represent novel, non-invasive and relatively simple procedures, which can be used in a longitudinal fashion to assess a patient's neurological response to therapies.

Hypervascularity of the glans penis diagnosed with cutaneous temperature measurements.

Hypervascularity of the penis is a complication that has been described after deep dorsal vein arterialization. We present a patient with hypervascularity of the penis which was diagnosed with cutaneous temperature measurements of the penis. Our patient underwent both pre- and post-operative cutaneous temperature measurements taken at seven locations along the shaft and glans of the penis with the Physitemp BTE-2A Thermal Sensitivity Tester. After deep dorsal vein arterialization our patient's cutaneous temperature at the glans increased 4.2 degrees C. After ligation of the distal deep dorsal vein for hypervascularity, the cutaneous temperature at the glans decreased 1.3 degrees C. We present a novel technique using cutaneous tempewrature measurements which may be used as a test for the efficacy of arterial revascularization and its potential complications.

Concentrated autologous plasma protein: a biochemically neutral solder for tissue welding.

BACKGROUND AND OBJECTIVE: Xenographic or allographic serum protein solders used for laser welding may have immunologic and/or pathogenic complications. The objective of these studies was to develop a safe, autologous solder. STUDY DESIGN/MATERIALS AND METHODS: Five methods of preparing concentrated autologous plasma protein solder (CAPPS) were evaluated. Next, the CAPPS was evaluated via (1) thermal denaturation studies using differential scanning calorimetry, (2) tissue welding studies to characterize both acute and healing properties. RESULTS: The optimal concentration method to produce CAPPS rapidly was a dialysis method using chemical (osmotic) forces. The CAPPS showed similar denaturation profiles to serum albumin (SA) solders. Acutely, CAPPS provided comparable breaking strengths to SA solders. At 7 days, there was no significant difference in breaking strength or histology between 50% human SA solder and CAPPS (using a porcine skin model). CONCLUSIONS: These studies demonstrate that the CAPPS system provides acceptable acute and chronic properties for laser welding.

Laser tissue welding: a biotechnological advance for the future.

Laser tissue welding as well as other alternative methods of closure will play a more important role in surgical specialties as laparoscopic, endoscopic, and microsurgical techniques continue to develop. Laser tissue welding uses laser energy to anastomose tissues and is ideally suited for applications in which suturing and stapling is difficult. Recent advances have led to a better understanding of the mechanisms of tissue welding. Additionally, technical achievements including the introduction of protein solders and temperature-controlled feedback systems have led to the acceptance of laser tissue welding in clinical medicine. In this article, we describe the history and development of laser tissue welding and review the current and potential applications of this technology.

Mechanism of healing following the Snodgrass repair.

PURPOSE: It has been suggested that healing after tubularized incised plate urethroplasty occurs through re-epithelialization with normal tissue ingrowth or by secondary intent through scarring. We investigated healing in tubularized incised plate urethroplasty. MATERIALS AND METHODS: Hypospadias was created in 5 dogs by incising the ventral urethra, allowed to heal for 21 days and subsequently repaired. During hypospadias creation a tattoo was made longitudinally in the midline dorsal urethral plate. The tattoo was bisected during repair, thus creating 2 distinct lines marking the edges of the incision. A neourethra was tubularized and closed in 2 layers. At 21 days the phallus was harvested, inspected and embedded for histology. RESULTS: The dorsal urethral plate incision contained 2 distinct lines in all samples representing the area of separation between the native and ingrowing urethras. The distance between these lines was 0.9 +/- 0.1 mm. Proximal urethral lumen diameter (3. 3 +/- 0.1 mm.) was not significantly different from that of the neourethral lumen (3.1 +/- 0.1 mm.). Histologically all repairs had intact squamous epithelium. There was normal appearing subepithelial architecture with scant perivascular lymphocytic infiltrates between the tattoos. In contrast, the area around the sutures showed a desmoplastic (fibroblastic) reaction with an inflammatory, primarily neutrophilic response. CONCLUSIONS: Healing of the incision in the dorsal urethral plate during tubularized incised plate urethroplasty occurs by re-epithelialization with normal tissue ingrowth. In contrast, the sutured closure heals with a desmoplastic and inflammatory response.

Differential scanning calorimetry of albumin solders: interspecies differences and fatty acid binding effects on protein denaturation.

BACKGROUND AND OBJECTIVE: Understanding albumin solder denaturation is important for laser tissue soldering. Human (HSA), bovine (BSA), porcine (PSA), and canine (CSA) albumin both fatty acid containing (FAC) and fatty acid free (FAF) were evaluated by using differential scanning calorimetry (DSC). STUDY DESIGN/MATERIALS AND METHODS: DSC was used to measure difference thermograms to determine the irreversible thermal denaturation profile for 50% albumin solutions. The denaturation transition's onset, end and peak temperatures, and enthalpy were measured. RESULTS: All FAC species, except BSA, exhibited twin peaked endotherms. Single endotherms were observed for all FAF species and BSA-FAC. Onset and end temperatures were significantly [P < 0.001] lower for all FAF species (except BSA's end temperature). There was a 30% decrease in the denaturation enthalpy between FAF and FAC groups. CONCLUSION: FAF albumin solders were found to denature at significantly lower temperatures, while also having a 30% reduction in enthalpy when compared with their FAC counterparts.

Semi-solid albumin solder improved mechanical properties for laser tissue welding.

BACKGROUND AND OBJECTIVE: A semi-solid albumin solder formulated with hydroxypropylmethylcellulose (HPMC) was designed to improve the characteristics of liquid and solid solders. STUDY DESIGN/MATERIALS AND METHODS: Acute tensile strengths were determined on canine small bowel in vitro by using liquid 50% bovine serum albumin (BSA), semi-solid 48% BSA with HPMC, and solid 60% BSA solder. Long-term healing of liquid and semi-solid solders, compared with a suture control, was evaluated in a porcine skin model, with tensile strength as well as histologic findings obtained on postoperative day 7. RESULTS: Acutely, semi-solid solder demonstrated a significantly (P < 0.05) higher tensile strength when compared with liquid or solid solder. At 7 days, HSA semi-solid and BSA semi-solid had significantly (P < 0.05) higher tensile strength than suture control; however, no differences were seen for liquid or solid solder groups. No differences in histology were appreciable between any of the solder groups in a porcine skin model. CONCLUSION: Acutely and at 7 days, semi-solid solder was stronger than 50% liquid albumin with better handling characteristics.

Welding characteristics of different albumin species with and without fatty acids.

BACKGROUND AND OBJECTIVE: Albumin solders from different species have been used for laser tissue welding without a complete understanding of possible differences between them. The breaking strength of four different species of serum albumin (human, bovine, porcine, and canine), both fatty acid containing (FAC) and fatty acid free (FAF), was determined to evaluate the welding ability of each type of albumin. STUYDY DESIGN/MATERIALS AND METHODS: Acute breaking strengths were determined on canine small bowel by using 50% albumin (FAF and FAC) from human, bovine (BSA), porcine, and canine species. RESULTS: BSA-FAC and BSA-FAF had a significantly higher (P < 0.05) breaking strength than all other groups; furthermore, BSA-FAC was significantly higher (P < 0.05) than BSA-FAF. There was no significant difference in breaking strength when FAF albumin was compared with FAC albumin from humans, pigs, or dogs. CONCLUSION: These experimental results show that species-specific and fatty acid-specific differences exist when these albumin solders are used for laser tissue welding. This finding suggests that modifications in albumin could be used to improve results through decreased thermal damage and increased weld strength.

Laser-assisted demucosalized gastrocystoplasty with autoaugmentation in a canine model.

OBJECTIVES: Laser-assisted autoaugmentation gastrocystoplasty has been performed successfully. Experiments were performed to determine the optimal laser for tissue welding during demucosalized autoaugmentation gastrocystoplasty using both a 1.9-microm diode and a 1.32-microm neodymium:yttrium-aluminum-garnet (Nd:YAG) laser with and without thermal control. METHODS: Autoaugmentation gastrocystoplasty was performed on 18 female mongrel dogs. Anastomoses were performed by either suture or laser welding with a 50% human albumin solution. A 1.9-microm diode laser was compared with a 1.32-microm Nd:YAG laser with and without thermal control. In vivo canine bladder capacity measurements were performed both before gastrocystoplasty and at euthanasia. The animals were studied on days 4 and 14. Samples of the anastomotic area from each group were taken to measure tensile strength. Histologic samples were assessed for tissue damage. RESULTS: There was a significant increase in bladder volume in the 4-day group compared with pregastrocystoplasty values. Both the 1.9-microm diode laser and suture control dogs with the 14-day repairs had significantly more tensile strength than their 4-day counterparts. In contrast, no statistical difference was found between the 4 and 14-day 1.32-microm Nd:YAG groups. The suture control group had evidence of minor tissue devitalization at the anastomosis at both 4 and 14 days. The 1.9 and 1.32-microm laser groups both had evidence of tissue devitalization at 4 and 14 days. The 1.32-microm laser group had primarily severe tissue injury. The laser groups at 14 days demonstrated an inflammatory reaction that was localized to the albumin. CONCLUSIONS: Demucosalized gastrocystoplasty with autoaugmentation can be safely and successfully performed with a 1.9-microm diode laser without significant differences in tensile strength when compared with suture controls. The 1.32-microm Nd:YAG laser can also be successfully used; however, the long-term results appear to be inferior to the 1.9-microm diode laser.

Box stitch modification of Hasson technique for pediatric laparoscopy.

Laparoscopy has been recognized as the modality of choice for the treatment of many diseases in urology, gynecology, and general surgery. Although laparoscopy is minimally invasive, the most frequent complications are associated with entry through the abdominal wall. The Hasson (open) technique was developed to minimize the complications by entering the abdomen under direct vision. We have modified the Hasson technique with a stitch that is easy to perform, creates a tight fascial seal, allows easy exchange of trocars, and produces an effect that is cosmetically appealing.