Historical and Current Practices in the Management of Fossa Navicularis Strictures.

PURPOSE OF REVIEW: Fossa navicularis strictures represent a surgically challenging disease process that requires detailed preoperative planning and an understanding of each patient's goals in order to achieve a satisfactory long-term outcome. This review summarizes the various approaches used in the management of fossa navicularis strictures over the past several decades. RECENT FINDINGS: In addition to existing evidence to support open flap- and graft-based reconstruction, recent studies suggest a potential role for limited open repair via a transurethral approach. Open repair of fossa navicularis strictures has become the standard of care with high success rates using local skin flaps or tissue grafts. There remains a very limited role for minimally invasive techniques in definitive management of this disease.

History of hypospadias: Lost in translation.

The evolution of hypospadias surgery can be classified under 3 periods that were closely related to advances in surgical instruments, introduction of anesthesia, and newer suture materials. Stretching dominated the early period, tunneling during the Middle Ages, and flaps during the modern period. Suture materials have included at various time silver wires, horsehair, and stainless steel. Examination and translation of the original manuscripts showed that Galen recommended stretching and suturing of glanular hypospadias and not amputation or partial penectomy as has been currently reported. The term chordee was first introduced in the 18th century in relation to gonorrhea and was defined as "painful imperfect erection of the penis during gonorrhea, with downward incurvation." This was a common complication of gonorrhea before the introduction of antibiotics. Mettauer, Duplay, Mayo, and others used the terms incurvation, ventral deformity, ventral curvature, and others. Clinton Smith in 1938 was the first surgeon to use the term congenital chordee in direct relation to hypospadias. The use of prepuce for urethroplasty, popular now, was first reported by Liston in 1838, Rochet in 1899, Russell in 1900, and Mayo in 1901. The two stage repair performed in the early 20th century differed from that in the early 21st century in that urethroplasty was performed in the first stage and only anastomosis to the original meatus was performed in the second stage. The two-stage repair, currently known as Bracka's two-stage repair, was first described in 1962 by Cloutier. The use of the urethral plate in epispadias was first described by Liston in 1838, Thiersch in 1869 and by Anger & Duplay in hypospadias in 1874. Partially epithelialized urethroplasty using the urethral plate was described by Duplay in 1880, Russell 1915, Denis Browne 1940, Reddy 1975, Orkiszewski 1987, Rich 1989, and Snodgrass in 1994. LEVEL OF EVIDENCE: V.

Aproximación histórica al tratamiento quirúrgico de la disfunción eréctil / Historical Approach to the Surgical Treatment of Erectile Dysfunction

Introducción: A través de la historia de la humanidad la disfunción eréctil ha supuesto uno de los problemas de salud más continuamente presentes. Como consecuencia se produjo una búsqueda de soluciones que, una tras otra, se demostraban como infructuosas. En este contexto la aparición de posibles cirugías a principios del siglo XX supuso una revolución que, aun así, tardaría varias décadas en demostrarse efectiva. Adquisición de evidencia: Se realiza una revisión bibliográfica que muestra el proceso en el desarrollo de posibles tratamientos quirúrgicos de recuperación hormonal para la disfunción eréctil, posteriormente, la irrupción de la cirugía vascular, con nuevas técnicas de anastomosis y, más adelante, el desarrollo de los implantes de prótesis peneanas como alternativa terapéutica. Síntesis de evidencia: La publicación de resultados obtenidos con la cirugía para la disfunción eréctil ha carecido durante décadas de falta de objetivación, al ser la función sexual un tema restringido a la privacidad de los pacientes. Esta situación ha llevado a una confianza sobre los resultados referidos por varios autores sin poderse constatar su auténtica credibilidad, demostrándose posteriormente que algunos de estos logros no eran reproducibles. Conclusiones: En el presente artículo se recuerdan algunos de los hitos más importantes en el avance de las cirugías diseñadas para tratar la disfunción eréctil. Los logros conseguidos, y también los aparentes fracasos, ofrecen un motivo de reflexión sobre cómo se ha avanzado hasta el momento presente y cómo se puede avanzar en un futuro cercano (AU)

Introduction: Throughout human history, erectile dysfunction has represented one of the most omnipresent health problems. This has resulted in a search for solutions that, one after the other, have been shown to be fruitless. In this context, the emergence of possible surgical solutions at the start of the 20th century represented a revolution that, even then, would take several decades to demonstrate their effectiveness. Acquisition of evidence: We performed a literature review that shows the process in the development of potential surgical treatments for hormonal restoration for erectile dysfunction, followed by the sudden emergence of vascular surgery, with new anastomosis techniques, and in the future, the development of penile prosthetic implants as alternative treatments. Summary of the evidence: The publication of results from erectile dysfunction surgery has been lagging for decades due to a lack of objectivity, given that sexual function is a topic restricted by patients’ privacy. This situation has led to a reliance on results reported by various authors whose actual credibility could not be verified, with subsequent demonstrations showing that some of these results were not reproducible. Conclusions: This article reviews some of the most important milestones in the progress of surgeries designed to treat erectile dysfunction. The achievements and apparent failures provide a reason for reflection on how we far we have come and how far we can go in the near future(AU)

Wilhelm Fabry's 1614 report on a giant condyloma of the penis.

For many years it has been the work of Buschke and Löwenstein that has justified calling the exophytic, locally destructive tumour of the anogenital mucosal surface 'giant condyloma of Buschke and Löwenstein' or GCBL. In order to investigate the early history of this rare disease we examined the writings of the barber-surgeon Wilhelm Fabry (1560-1634) who had a serious interest in dermatological disorders and their treatment. We analysed Fabry's 600 Latin case reports and identified the case of a 'monstrous penile tumour'. We then translated this text into English and compared it point by point with later publications. This was followed by a cursory review of surgical treatises from the 16th to the 18th centuries. In 1614 Fabry described and depicted a tumour of the penis; the clinical characteristics (gradual formation of a warty lesion, considerable size, invasive growth, absence of metastases) indicated it was a giant condyloma. His mention of the urethral fistulization enables discrimination from 'common' condylomata acuminata, and the survival period of 10 years after amputation allows exclusion of a 'true' carcinoma. This report is singular among 17th-century case histories. The neoplasias described 300 years later are most probably biologically identical. Thus, Fabry's is the first clinical report; the histological classification, however, belongs to Buschke and Löwenstein. From now on the disease should be designated with the eponym giant condyloma of Fabry-Buschke-Löwenstein or GCFBL.

Hypospadias: a 30-year personal journey.

Hypospadias represents a spectrum. As such, every child with hypospadias requires a dedicated surgeon who exercises appropriate judgment, and has the experience to correct each variant surgically. Over the past 3 decades, the approach to the boy with hypospadias has evolved due to the employment of newer surgical techniques, in association with an increased understanding of the embryology and anatomy of the penis, embracement of psychological advances, and with the increased safety of anesthesia. Many questions remain unanswered, and thus, surgeons must be amenable to change, as advances continue. Only by properly questioning the long-term results of past and current techniques, will we be able to truly assess the products of our toils.

Urethral strictures.

What's known on the subject? and What does the study add? Urethral strictures are common and increasingly common in an ageing population. The treatment is controversial and particularly the relative roles of urethrotomy or urethral dilatation on the one hand and urethroplasty on the other. This review aims to provide a comprehensive overview of the subject including less commonly discussed issues such as the history and pathology of stricture disease. We would hope that a comprehensive overview of the subject will give a sharper perspective to aid the investigation and management of patients with urethral strictures.

Breve semblanza y recuerdo del profesor Cifuentes Delatte, como miembro de la Real Academia Nacional de Medicina / Brief life sketch and memories of Professor Dr. Luis Cifuentes Delatte, as a member of the National Royal Academy of Medicine

Durante mi formación en la Clínica Universitaria de Urología de Munich y en el Hospital GroBhodern, pude comprobar el prestigio que tenía el Dr. Cifuentes Delatte entre mis maestros, que además de conocerle personalmente, hacían a menudo referencia, a sus trabajos científicos. Detallo la ocasión en que le conocí durante mi ingreso como Académico Correspondiente de la Real Academia de Medicina y las conversaciones que tuvimos en las sesiones de la Academia, así como la amistad que terminé teniendo con él (AU)

During my training in the University Clinic of Urology in Munich and Gro-Bhodern Hospital I could realize the prestige Dr. Cifuentes Delatte had among my Professors, who in addition to knowing him personally made frequent references to his scientific works. I write in detail the time I met him during my admission in the Royal Academy of Medicine as a Correspondent Academician and the conversations we had during the sessions of the Academy, as well as the friendship I finally had with him (AU)

The prepuce: preservation and reconstruction.

PURPOSE OF REVIEW: To analyze the role of prepuce preservation in various disorders and discuss options available to reconstruct the prepuce. RECENT FINDINGS: The prepuce can be preserved in selected cases of penile degloving procedures, phimosis or hypospadias repair, and penile cancer resection. There is no clear evidence that debilitating and persistent preputial lymphedema develops after a prepuce-sparing penile degloving procedure. In fact, the prepuce can at times be preserved even if lymphedema develops. The prepuce can potentially be preserved in both phimosis and hypospadias repair. Penile cancer localized to the prepuce can be excised using Mohs' micrographic surgery without compromising survival. Reconstruction of the prepuce still remains a theoretical topic. There has been no study that has systematically evaluated efficacy of any reconstructive procedures. SUMMARY: The standard practice for preputial disorders remains circumcision. However, prepuce preservation is often technically feasible without compromising treatment. Preservative surgery combined with reconstruction may lead to better patient satisfaction and quality of life.

Is laparoscopy dying for radical prostatectomy?

Training in laparoscopic urology, extensive experimental work, and dedicated surgical performance constitute the foundation of advanced laparoscopic urology, which is currently a reasonable surgical option in pediatrics, reconstructive surgery, and oncology. This article discusses topics related to laparoscopic approaches for radical prostatectomy, focusing on their introduction, development, accomplishments, and current standards and future goals for the minimally invasive treatment of urologic diseases. We highlight the dynamic status of the laparoscopic approach for radical prostatectomy (pure or robotic-assisted) that constitutes one of the most rapidly evolving fields in urology.

La patología urológica en la obra de abulcasis / Urological diseases in the works of Abulcasis

OBJETIVO: Realizar un estudio de la obra quirúrgica de Abulcasis en el campo de la Urología, conocer el instrumental y las diferentes técnicas empleadas así como las innovaciones introducidas para solucionar algunos aspectos de la patología urológica. MÉTODOS: Se ha revisado y traducido del latín la parte urológica del libro XXX del Tasrif utilizando la edición editada en Estrasburgo en 1532. RESULTADOS: El autor apenas se refiere a los aspectos clínicos de las diferentes patologías del aparato genitourinario centrándose en el tratamiento quirúrgico de las mismas. Utiliza con asiduidad el cauterio sobre todo para controlar la hemorragia en las diferentes intervenciones. Se puede comprobar que algunos pasos quirúrgicos se continúan practicando en la actualidad. CONCLUSIONES: Abulcasis es el primer médico nacido en España que estudia el tratamiento quirúrgico de la patología urológica y que hace un estudio gráfico del instrumental utilizado. Aporta innovaciones técnicas en diversas intervenciones y describe por primera vez la talla vesical en la mujer, la litotricia vesical y uretral

OBJECTIVES: To perform a study on the surgical work of Abulcasis in the field of urology, to know the surgical tools and different techniques used, as well as the innovations applied to solve some features of urological diseases. METHODS: The part on urology from the book XXX by Tasrif, the edition from Strasbourg in 1532 was reviewed and translated from Latin. RESULTS: The author does not refer much to the clinical features of the various pathologies of the genitourinary apparatus; he focuses instead on the surgical treatment of them. The author usually used the «cautery» mainly to control hemorrhage in various operations. Some of these surgical practices are being used nowadays. CONCLUSIONS : Abulcasis was the first doctor born in Spain that studied the surgical treatment of urological diseases and performed a graphic study on the tools used. He introduced technical innovations on different operations and described for the first time the vesical lithotomy on women, and vesical and urethral lithotripsy (AU)

[Contribution of Etienne-Frederic Bouisson (1813-1884) to the surgical treatment of hypospadias]. / Etienne-Frédéric Bouisson (1813-1884) et le traitement chirurgical de l'hypospadias.

Professor Bouisson was a great surgeon and benefactor of medicine. He exercised successfully the functions of dean, rector and deputy. A great part of his surgical work deal with pediatric urology. Bouisson's dissertation on surgical treatment of hypospadias constitute a crucial turning-point in the history of treatment of this malformation.

[Victor Rochet (1860-1934), founder of Lyons' Urology and his contribution to surgical treatment of hypospadias]. / Victor Rochet (1860-1934), fondateur de l'urologie lyonnaise et son apport a la cure chirurgicale de l'hypospadias.

Through this article we present the scientific portrait of Victor Rochet, founder of Lyons' Urology, and we emphasize on his two procedures of hypospadias' surgical treatment.

Nikolaj A. Bogoraz (1874-1952): pioneer of phalloplasty and penile implant surgery.

Phalloplasty and penile implants are outstanding pioneering procedures introduced in 1936 by the Russian surgeon Nikolaj A. Bogoraz and are thus of eminent interest to the urological and plastic surgeon. This article from the history of medicine will discuss his biography and scientific achievements during the first half of the 20th century.