Allen F Morey

University of Texas Southwestern Medical Center, Dallas, Texas, United States

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Publications (254)941.68 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To present an updated experience using our previously reported lateral perineal '7-flap' technique for perineal urethrostomy (PU), highlighting its role in a variety of patients with advanced urethral stricture disease. All patients who underwent 7-flap PU from 2009-2013 were reviewed. PU was constructed by advancing a "7"-shaped laterally based perineal skin flap into a spatulated, amputated bulbomembranous urethra. The contralateral side of the amputated proximal urethra was then matured to the advanced perineal skin. Patients were stratified by body mass index (BMI) and outcomes were compared. Among 748 patients undergoing urethroplasty during the study period, 22 men (2.9%; mean age 61, range 31-80) received a 7-flap PU for advanced stricture disease (mean follow up 32 months). A majority of patients (14/22, 64%) were obese (BMI = 30). Disease etiologies consisted primarily of lichen sclerosus (9/22, 41%) while 6/22 (27%) had failed prior urethral reconstructions elsewhere. Mean operative time was 108 min (range 54-214), mean estimated blood loss (EBL) was 76 cc (30-200), and all patients were discharged immediately after surgery. Urethrostomy creation was possible in all patients regardless of BMI (mean 33, range 22-43), and there were no differences with regards to EBL (p = 0.71), operative time (p = 0.38), or success rate (p = 0.76) in obese versus non-obese patients undergoing 7-flap PU. Nearly all patients (21/22, 95%) are voiding spontaneously on follow up without the need for any additional procedure. In our updated experience, performance of 7-flap urethrostomy has resulted in durable long term success with acceptable performance in technically challenging cases.
    The Canadian Journal of Urology 08/2015; 22(4):7902-6. · 0.98 Impact Factor
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    ABSTRACT: To examine surgical case volume characteristics among certifying urologists associated with treatment of urethral stricture to compare practice patterns of recent graduates to recertifying attending urologists and trends over time. Six month case log data of certifying and recertifying urologists (2003-2013) was obtained from the American Board of Urology (ABU). Cases specifying a CPT code for urethral dilation, direct vision internal urethrotomy (DVIU), urethroplasty and graft harvest in males ≥18 years were analyzed for surgeon-specific variables. Among 6320 urologists logging at least one reconstructive urology procedure, 95,747 (86.2%) urethral dilations, 10,986 (10.0%) DVIU and 4349 (3.9%) urethroplasties were identified, with 99 (0.9%) utilizing graft and 405 (9.3%) staged procedures. Overall ratio of urethral dilation/DVIU to urethroplasty was 24.5:1. More recent log year and new certification correlated with a decrease in ratio of dilation/DVIU to urethroplasty, but stable use of graft. The ratio of dilation/DVIU to urethroplasty for new certification was much lower (7.9:1), compared to first (24.4:1), second (63.3:1), and third recertification cycles (99.5:1), wherein urethroplasty was increasingly rare. Newly certifying urologists performed urethroplasty 4.5 times more often than those recertifying. Academically-affiliated urologists were eight times more likely to perform urethroplasty. Most urethral strictures are treated with dilation/DVIU, but a changing paradigm favoring urethroplasty is evident. Most urethroplasties are performed by a small number of urologists with high volume, academic affiliation, recent residency graduation, and residence in a state with a reconstructive urology fellowship. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 07/2015; DOI:10.1016/j.urology.2015.07.020 · 2.19 Impact Factor
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    ABSTRACT: To present a novel algorithm for definitive reconstruction of penile curvature in men undergoing inflatable penile prosthesis (IPP) surgery as an alternative to manual penile modeling and grafting procedures. Patients with erectile dysfunction and concomitant penile curvature undergoing IPP placement were divided into two treatment groups: group 1- penile deformity known preoperatively; group 2 - penile curvature recognized intraoperatively after IPP placement. Group 1 patients underwent penile plication after artificial erection and immediately prior to IPP insertion via the same penoscrotal incision, while group 2 patients were treated with a Yachia (Heineke-Mikulicz) corporoplasty over the intact cylinders. Patients completed post-operative Patient Global Impression of Improvement (PGI-I) questionnaires assessing overall satisfaction. Among 405 men receiving IPP at our institution from 2007-2014, 30 patients received synchronous correction of penile curvature (7%). Group 1 included 23/30 (77%) patients, and 7/30 (23%) were in group 2. Overall mean initial curvature was 36° and all patients were corrected to <10°. Average operative times were 18 minutes longer compared to patients who underwent IPP placement alone (82 versus 64 minutes, p<0.05). At an average follow-up of 13 months (range 7-32), 19/20 (95%) group 1 and 6/7 (86%) group 2 patients who completed surveys reported an improved overall condition. No patient reported chronic pain, recurrent deformity, or device malfunction. Penile curvature can be safely and reliably corrected at the time of IPP placement, regardless of whether the deformity was identified preoperatively. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 07/2015; DOI:10.1016/j.urology.2015.06.042 · 2.19 Impact Factor
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    ABSTRACT: We present a novel technique using ventral slit with scrotal skin flaps (VSSF) for the reconstruction of adult buried penis without skin grafting. An initial ventral slit is made in the phimotic ring, and the penis is exposed. To cover the defect in the ventral shaft skin, local flaps are created by making a ventral midline scrotal incision with horizontal relaxing incisions. The scrotal flaps are rotated to resurface the ventral shaft. Clinical data analyzed included preoperative diagnoses, length of stay, blood loss, and operative outcomes. Complications were also recorded. Fifteen consecutive patients with a penis trapped due to lichen sclerosus (LS) or phimosis underwent repair with VSSF. Each was treated in the outpatient setting with no perioperative complications. Mean age was 51 years (range, 26-75 years), and mean body mass index was 42.6 kg/m(2) (range, 29.8-53.9 kg/m(2)). The majority of patients (13 of 15, 87%) had a pathologic diagnosis of LS. Mean estimated blood loss was 57 cc (range, 25-200 cc), mean operative time was 83 minutes (range, 35-145 minutes), and all patients were discharged on the day of surgery. The majority of patients (11 of 15, 73.3%) remain satisfied with their results and have required no further intervention. Recurrences in 3 of 15 (20.0%) were due to LS, panniculus migration, and concealment by edematous groin tissue; 2 of these patients underwent subsequent successful skin grafting. VSSF is a versatile, safe, and effective reconstructive option in appropriately selected patients with buried penis, which enables reconstruction of penile shaft skin defects without requiring complex skin grafting. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 04/2015; 85(6). DOI:10.1016/j.urology.2015.02.030 · 2.19 Impact Factor
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    ABSTRACT: Objectives: To examine case volume characteristics among certifying urologists performing male sling and AUS to evaluate practice patterns in male stress urinary incontinence (SUI). Methods: Six-month case log data of certifying urologists (2003-2013) was obtained from the American Board of Urology (ABU). Cases specifying CPT code for male sling, AUS, and removal or revision of either modality in males ≥18 years were analyzed. Results: Among 1615 urologists (568 certifying and 1047 recertifying) logging at least one male incontinence procedure, 2109 (48% of all procedures) male sling and 2284 (52%) AUS cases were identified. Mean age of patients undergoing AUS was 74.9 years and 67.3 years in sling patients (p<0.001). An increase in male incontinence procedures from 2003 to 2013 was demonstrated. The rate of male sling increased from 32.7% of incontinence surgeries in 2004 to 45.5% in 2013 (p<0.001). Academically affiliated urologists are 1.5 times more likely to perform AUS than male sling for SUI (p<0.001). Median number of slings performed was two (range 1-40), with 32.7% placing slings exclusively. A small group of certifying urologists (3.4%) accounted for 22% of all male slings placed. This same cohort logged 10.2% of all AUS. Surgical management of male SUI varies widely across states (p<0.001), with slings performed between 21-70% of the time. Conclusions: Overall the number of male incontinence procedures has increased over time, with a growing proportion of male slings. Most slings and AUS cases are performed by a small number of high-volume surgeons.
    The Journal of Urology 04/2015; 193(4):e1097. DOI:10.1016/j.juro.2015.02.1846 · 4.47 Impact Factor
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    ABSTRACT: We compared the results of initial excision and primary anastomosis (EPA) urethroplasty to EPA outcomes from other challenging re-operative clinical settings (secondary [prior urethroplasty of any technique other than EPA] and repeat [prior EPA] cases). We reviewed our database of patients who underwent EPA urethroplasty for bulbar urethral stricture at our tertiary referral center from 2007 to 2014. Patients without available data and those with a history of lichen sclerosus, radiation, pelvic fracture urethral injuries, distal strictures and/or hypospadias were excluded from analysis. Patient characteristics and outcomes were compared between those undergoing initial, secondary, and repeat EPA urethroplasty for bulbar urethral stricture. Among 898 urethroplasties performed over the study period, we identified 305 men who underwent EPA urethroplasty of the bulbar urethra (initial EPA 268/305, 88%; re-operative EPA 37/305, 12%). Among re-operative cases, 18/37 (49%) had a secondary EPA following a different type of prior urethroplasty and 19/37 (51%) had a repeat EPA. Repeat EPA in the bulbar urethra was successful in 18/19 patients (95%), which was comparable to the success rate of initial bulbar EPA (251/268, 94%) as well as secondary bulbar EPA (17/18, 94%; P=0.975) with similar mean stricture length. The mean follow up for all patients was 41.5 months (range 6-90 months) and the mean follow up within each group was greater than 30 months. Repeat EPA urethroplasty has excellent results for short bulbar strictures, comparable to those achieved in the initial and secondary setting. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of urology 04/2015; 193(4):e477-e478. DOI:10.1016/j.juro.2015.02.1446 · 4.47 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e474-e475. DOI:10.1016/j.juro.2015.02.1438 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e719. DOI:10.1016/j.juro.2015.02.2137 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e159. DOI:10.1016/j.juro.2015.02.884 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e1097-e1098. DOI:10.1016/j.juro.2015.02.1848 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e969. DOI:10.1016/j.juro.2015.02.2766 · 4.47 Impact Factor
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    The Journal of Urology 04/2015; 193(4):e566. DOI:10.1016/j.juro.2015.02.1077 · 4.47 Impact Factor
  • The Journal of Urology 04/2015; 193(4):e967-e968. DOI:10.1016/j.juro.2015.02.2762 · 4.47 Impact Factor
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    ABSTRACT: To determine variability in urethral stricture surveillance. Urethral strictures impact quality of life and exact a large economic burden. Although urethroplasty is the gold standard for durable treatment, strictures recur in 8%-18%. There are no universally accepted guidelines for posturethroplasty surveillance. We performed a literature search to evaluate variability in surveillance protocols, analyzed costs, and reviewed performance of each commonly used modality. MEDLINE search was performed using the keywords "urethroplasty," "urethral stricture," and "stricture recurrence" to ascertain commonly used surveillance strategies for stricture recurrence. We included English language articles from the past 10 years with at least 10 patients, and age >18 years. Cost data were calculated based on standard 2013 Centers for Medicare and Medicaid Services physician's fees. Surveillance methods included retrograde urethrogram or voiding cystourethrogram, cystourethroscopy, urethral ultrasound, American Urological Association Symptom Score, and postvoid residual and urine flowmetry (UF) measurement. Most protocols call for a retrograde urethrogram or voiding cystourethrogram at the time of catheter removal. After this, UF or PVR, cystoscopy, urine culture, or a combination of UF and American Urological Association Symptom Score was performed at variable intervals. The first-year follow-up cost of anterior urethral surgery ranged from $205 to $1784. For posterior urethral surgery, follow-up cost for the first year ranged from $404 to $961. Practice variability for surveillance of urethral stricture recurrence after urethroplasty leads to significant differences in cost. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urology 03/2015; 85(5). DOI:10.1016/j.urology.2014.12.047 · 2.19 Impact Factor
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    Timothy J. Tausch · Allen F. Morey
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    ABSTRACT: To review previous reports and present our experience on the outcomes after treating pelvic fracture urethral injuries (PFUIs) with primary endoscopic realignment (PER) vs. placing a suprapubic tube (SPT) with elective bulbomembranous anastomotic urethroplasty (BMAU). We reviewed previous reports and identified articles that reported outcomes after PER vs. SPT and elective BMAU for patients who sustained PFUIs. We also present our institutional experience of treating patients who were referred after undergoing either form of treatment. The success rates for PER after PFUI are wide-ranging (11-86%), with variable definitions for a successful outcome. At our institution, for patients treated by SPT/BMAU, the mean time to a definitive resolution of stenosis was dramatically shorter (6 months, range 3-15) than for those treated with PER (122 months, range 4-574; P < 0.01). The vast majority of patients treated by PER required multiple endoscopic urethral interventions (median 4, range 1-36;P < 0.01) and/or had various other adverse events that were rare among the SPT/BMAU group (14/17, 82%, vs. 2/23, 9%;P < 0.05). While PER occasionally results in urethral patency with no need for further intervention, the risk of delay in definitive treatment and the potential for adverse events have led to a preference for SPT and elective BMAU at our institution.
    Arab Journal of Urology 02/2015; 161(1). DOI:10.1016/j.aju.2014.12.005
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    ABSTRACT: To compare functional outcomes of those receiving artificial urinary sphincter (AUS) pressure regulating balloons (PRB) within the space of Retzius (SOR) versus those placed in a high submuscular (HSM) location. We reviewed a prospectively maintained database of AUS patients between July 2007 and December 2014. After cuff placement was completed via a perineal incision, 61-70 cm H2O PRBs were placed through a separate high scrotal incision in either a HSM tunnel or within the SOR. Demographics, perioperative comorbidities, and functional outcomes were compared between groups. A total of 294 consecutive patients underwent AUS placement with a mean follow up of 23 months. SOR placement was performed in 140 (48%) patients while HSM placement was performed in 154 (52%). Functional outcomes including continence (defined as 0-1 pads/day) (81% vs. 88%, p=0.11), erosion (9% vs. 8%, p=0.66), and explantation (10% vs. 11%, p=0.62) rates were similar between groups. AUS revisions for persistent incontinence were required in similar proportions for both groups (13% vs. 8%, p=0.16), with comparable mean follow-up (24 vs. 23 months, p=0.30). Kaplan-Meier analysis revealed no difference between groups with regards to rates of explantation (p=0.70) or revision (p=0.06). High submuscular placement of the PRB at the time of AUS surgery is a safe and effective alternative with equivalent functional outcomes to traditional placement in the SOR. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
    The Journal of Urology 02/2015; 194(1). DOI:10.1016/j.juro.2015.01.115 · 4.47 Impact Factor
  • Timothy J. Tausch · James Ryan Flemons · Allen F. Morey
    Journal of Sexual Medicine 02/2015; 12(2). DOI:10.1111/jsm.12837 · 3.15 Impact Factor
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    Jordan Siegel · Timothy Tausch · Allen Morey
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    ABSTRACT: Artificial urinary sphincter (AUS) cuff erosion is a challenging complication traditionally managed with device removal and Foley catheter drainage. Urethral stricture can result secondary to the healing process, delaying AUS reimplantation. In situ urethroplasty (ISU) technique is a definitive repair at the time of device removal. Early results demonstrate a decreased rate of stricture formation compared to traditional management with little additional operative time and no additional complications. Patients undergoing ISU have less delay prior to AUS reimplantation, leading to possible benefit in health-related quality of life (HRQL) outcomes.
    Translational Andrology and Urology 01/2015; 4(1):56-59. DOI:10.3978/j.issn.2223-4683.2015.01.12
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    ABSTRACT: Refractory ischemic priapism (RIP) can be difficult to treat, consuming significant healthcare-related resources. Acute insertion of a malleable penile prosthesis (MPP) has been reported as an effective therapy that treats the priapism and restores sexual function. We report our 6-year, urban public hospital experience with acute insertion of MPP in patients with RIP. We retrospectively reviewed the records of patients receiving MPPs for RIP from 2007 to 2013. Data analyzed included duration of erection, number of emergency room (ER) visits, hospital admissions, days of hospitalization, and postoperative course. Costs were estimated using standard Medicare reimbursement rates. Healthcare-related costs of treatment of RIP episodes in men presenting to our institution. During the study period, 14 men underwent MPP placement acutely for refractory priapism. Thirteen presented with RIP, and one had stuttering priapism over a 14-day hospitalization. Etiologies included sickle cell anemia (4/13, 29%), medication-induced (3/14, 21%), and idiopathic (7/14, 50%). Average preoperative duration of RIP was 82 hours with considerable consumption of health-care resources (average US $83,818 estimated cost, 4 ER visits [range 1-27], 2 hospital admissions [range 1-5], 1.5 shunt procedures [range 1-3], 5 irrigation and drainage procedures using phenylephrine injection [range 2-20], and 5 hospital admission days [range 2-14]). All patients were discharged within 24 hours of MPP surgery. The management of RIP is associated with multiple ER visits, prolonged hospital admissions, and significant resource utilization. MPP insertion is efficacious for the immediate resolution of refractory priapism, with potential cost and resource benefits. Tausch TJ, Zhao LC, Morey AF, Siegel JA, Belsante MJ, Seideman CA, and Flemons JR. Malleable penile prosthesis is a cost-effective treatment for refractory ischemic priapism. J Sex Med **;**:**-**. © 2014 International Society for Sexual Medicine.
    Journal of Sexual Medicine 12/2014; 12(3). DOI:10.1111/jsm.12803 · 3.15 Impact Factor
  • Allen F Morey · Paul H Chung · Timothy J Tausch
    Urology 12/2014; 84(5):1233. DOI:10.1016/j.urology.2014.05.066 · 2.19 Impact Factor

Publication Stats

3k Citations
941.68 Total Impact Points


  • 2008–2015
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, Texas, United States
    • Parkland Memorial Hospital
      Dallas, Texas, United States
  • 2014
    • University of Cincinnati
      Cincinnati, Ohio, United States
    • University College London Hospitals NHS Foundation Trust
      Londinium, England, United Kingdom
    • Rush University Medical Center
      • Department of Urology
      Chicago, Illinois, United States
    • University of Washington Seattle
      • Department of Urology
      Seattle, Washington, United States
    • Duke University Medical Center
      • Department of Pathology
      Durham, North Carolina, United States
    • Nashville Online
      Нашвилл, Michigan, United States
    • CUNY Graduate Center
      New York, New York, United States
  • 2013–2014
    • Memorial Sloan-Kettering Cancer Center
      • Department of Surgery
      New York, New York, United States
    • University of Southern California
      Los Ángeles, California, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
    • Vascular and Interventional Radiology
      Chicago, Illinois, United States
  • 2012–2014
    • Alexandria University
      • Department of Urology
      Al Iskandarīyah, Alexandria, Egypt
    • Michigan Institute of Urology
      Detroit, Michigan, United States
    • Detroit Medical Center
      Detroit, Michigan, United States
    • Sohag University
      Sawhāj, Sūhāj, Egypt
    • The University of Tennessee Medical Center at Knoxville
      • Department of Surgery
      Knoxville, Tennessee, United States
    • University of Toledo
      • Department of Surgery
      Toledo, Ohio, United States
    • University of Maryland, Baltimore
      • Department of Surgery
      Baltimore, Maryland, United States
  • 2011–2013
    • University of Texas at Dallas
      Richardson, Texas, United States
    • Urology Centers of Alabama
      Homewood, Alabama, United States
    • Universitair Ziekenhuis Leuven
      Louvain, Flemish, Belgium
    • Cairo University
      • Faculty of Medicine
      Al Qāhirah, Muḩāfaz̧at al Qāhirah, Egypt
    • Children's Memorial Hospital
      Chicago, Illinois, United States
    • Mansoura University
      • Urology and Nephrology Center
      El-Manṣûra, Muḩāfaz̧at ad Daqahlīyah, Egypt
    • Medical College of Wisconsin
      • Department of Urology
      Milwaukee, Wisconsin, United States
  • 2008–2013
    • Madigan Army Medical Center
      Tacoma, Washington, United States
  • 2011–2012
    • Ludwig-Maximilians-University of Munich
      • Department of Urology
      München, Bavaria, Germany
    • Wake Forest School of Medicine
      • Department of Urology
      Winston-Salem, North Carolina, United States
  • 1998–2011
    • Brooke Army Medical Center
      Houston, Texas, United States
  • 2010
    • University of North Texas at Dallas
      Dallas, Texas, United States
  • 2005
    • Loyola University Medical Center
      • Department of Urology
      Maywood, Illinois, United States
    • Hospital Universitario Virgen de las Nieves
      Granata, Andalusia, Spain
  • 1996–2004
    • University of California, San Francisco
      • Department of Urology
      San Francisco, California, United States
  • 2002
    • Wilford Hall Ambulatory Surgery Center
      Lackland Air Force Base, Texas, United States
    • Walter Reed National Military Medical Center
      • Department of Surgery
      Washington, Washington, D.C., United States
  • 1999
    • Uniformed Services University of the Health Sciences
      • Department of Surgery
      Bethesda, MD, United States
  • 1995
    • William Beaumont Army Medical Center
      El Paso, Texas, United States
  • 1989–1994
    • Tripler Army Medical Center
      Honolulu, Hawaii, United States