Erectile function after anterior urethroplasty.

PURPOSE: We ascertained the impact of anterior urethroplasty on male sexual function. MATERIALS AND METHODS: A validated questionnaire was mailed to 200 men who underwent anterior urethroplasty to evaluate postoperative sexual function. Questions addressed the change in erect penile length and angle, patient satisfaction with erection, preoperative and postoperative coital frequency, and change in erection noted by the sexual partner. Results were stratified by the urethral reconstruction method, namely anastomosis, buccal mucosal graft, penile flap and all others, and compared with those in a similar group of men who underwent circumcision only. RESULTS: Of the 200 men who underwent urethroplasty 152 who were 17 to 83 years old (mean age 45.7) completed the questionnaire. Average followup was 36 months (range 3 to 149). Overall there was a similar incidence of sexual problems after urethroplasty and circumcision. Penile skin flap urethroplasty was associated with a slightly higher incidence of impaired sexual function than other procedures (p >0.05). Men with a longer stricture were most likely to report major changes in erectile function and penile length (p <0.05) but improvement was evident with time in 61.8%. CONCLUSIONS: Overall anterior urethral reconstruction appears no more likely to cause long-term postoperative sexual dysfunction than circumcision. Men with a long stricture may be at increased risk for transient erectile changes.

Repair of the complications of hypospadias surgery.

In 1992 a retrospective review was conducted of 190 patients evaluated and treated for complications of hypospadias surgery during 1979 through 1990 at the Devine Center for Genitourinary Reconstructive Surgery of Sentara Norfolk General Hospital and Children's Hospital of the King's Daughters. We could not contact 13 patients and 8 are awaiting a second stage procedure. Of the 177 patients 167 (94.35%) have had a successful outcome, defined as a controllable urinary stream, functional erection and an acceptable cosmetic appearance, and 2 (1.13%) are considered failures. Details of presenting problems, surgical techniques and recent modifications of these procedures are presented.

Management of the spastic urinary sphincter.

Alpha blockade is a well-established form of therapy for bladder outlet obstruction. We introduce a new drug to the regimen that appears to facilitate relaxation of both the bladder outlet and external sphincter mechanism in patients with a spastic urinary sphincter.

Problematic vascular reconstruction in liver transplantation. Part I. Arterial.

Arterial inflow is essential for graft function after liver transplantation. Sometimes the recipient celiac axis is not suitable for anastomosis, and in these cases a conduit from either the aorta or iliac artery is an alternative. We retrospectively reviewed 32 patients who required arterial conduits and compared them with a matched control group who underwent standard arterial reconstruction (donor celiac artery to recipient celiac artery). The indications and surgical technique for arterial conduits are presented. There were no differences in intraoperative vascular flow studies, postoperative liver function, or incidence of rejection in the two groups. There were, however, more deaths in the conduit group, two of which are related to the retropancreatic conduit technique, with the others caused by the patients' underlying condition at transplantation. There was no morbidity or death associated with the antepancreatic conduit techniques. We therefore believe the use of arterial conduits from the aorta or iliac artery, when placed antepancreatically, are safe and should be used without reservation when indicated.