Allen F Morey

Vienna General Hospital, Wien, Vienna, Austria

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Publications (266)982.88 Total impact

  • Doron S Stember · Tobias S Kohler · Allen F Morey ·
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    ABSTRACT: Introduction: Distal extrusion of penile prosthesis cylinders is a challenging problem that is associated with pain and imminent erosion through penile skin. Distal extrusion and other perforation injuries, including crural and urethral, are other manifestations of tunica albuginea injuries that result in poor clinical outcomes and patient satisfaction. Aim: A description of Dr. John Mulcahy's landmark article for management of lateral extrusion is presented along with discussion of techniques for managing other types of perforation injuries associated with penile implants. Methods: Dr. Mulcahy's original article is reviewed and critiqued. Surgical methods to manage perforation injuries are discussed. Main outcomes measures: The main outcome measures used were the review of original article, subsequent articles, and commentary by Dr. Mulcahy. Results: Knowledge of techniques for management intraoperative and postoperative complications related to tunical perforation is necessary for implant surgeons. Conclusions: Perforation injuries are challenging noninfectious complications of penile prosthesis surgery. Familiarity with techniques to manage these problems is essential for ensuring good outcomes and patient satisfaction. Stember DS, Kohler TS, Morey AF. Management of perforation injuries during and following penile prosthesis surgery. J Sex Med 2015;12(suppl 7):456-461.
    Journal of Sexual Medicine 11/2015; 12 Suppl 7(S7):456-461. DOI:10.1111/jsm.12997 · 3.15 Impact Factor
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    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
  • Allen F. Morey ·

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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: 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):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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    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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    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):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
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    ABSTRACT: Objectives: To review recent trends in the treatment of PD, we assess surgical practice patterns of urologists in the United States with emphasis on specialty training, demographics, and temporal changes. Methods: Six month case log data of American urologists between 2004 and 2013 was obtained from the American Board of Urology. CPT codes were used to identify surgical procedures, including plaque injection. Results: A total of 6,564 urologists were included in the surgical cohort logging 8,195 surgical procedures for PD. Only 15.4% (1012/6564) of urologists reported a surgical case for PD. Andrologists (urologist subspecialty designation) accounted for 5.3% (54/1012) of these urologists and performed 18.5% of PD procedures (p=0.0001). The frequency of plaque injections increased from 499 in 2004 to 797 in 2013, a 59% increase, while surgical correction remained stable. Urologists performed four-times as many injections as surgical procedures for PD (p=0.001) with andrologists more likely to attempt injection than surgical correction (p=0.045). Among surgeries performed, 73.2% were corrections of angulation without plaque excision, 20.5% were excisions of plaque (with possible grafting) up to 5 cm, and 6.2% were excisions of plaque (with possible grafting) greater than 5 cm. There was a 313% increase in the ratio of plication to plaque manipulation (0.92 in 2004 to 2.91 in 2013). Conclusions: Peyronie's disease is treated by a minority of urologists and disproportionately by sub-specialist in andrology. When compared to surgical interventions, excluding prosthesis implantation, most surgeons favor conservative treatment. The majority of surgical corrections were corrections of angulation without plaque manipulation.
    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
  • Allen F Morey ·

    The Journal of Urology 02/2015; 193(2):626. DOI:10.1016/j.juro.2014.11.045 · 4.47 Impact Factor

Publication Stats

3k Citations
982.88 Total Impact Points


  • 2015
    • Vienna General Hospital
      Wien, Vienna, Austria
  • 2008-2015
    • University of Texas Southwestern Medical Center
      • Department of Urology
      Dallas, Texas, United States
    • Parkland Memorial Hospital
      Dallas, Texas, United States
    • Madigan Army Medical Center
      Tacoma, Washington, United States
  • 2014
    • Nashville Online
      Нашвилл, Michigan, United States
    • University College London Hospitals NHS Foundation Trust
      Londinium, England, United Kingdom
    • University of Cincinnati
      Cincinnati, Ohio, United States
    • Rush University Medical Center
      • Department of Urology
      Chicago, Illinois, United States
    • Duke University Medical Center
      • Department of Pathology
      Durham, North Carolina, United States
    • CUNY Graduate Center
      New York, New York, United States
    • University of Washington Seattle
      • Department of Urology
      Seattle, Washington, 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
    • Vascular and Interventional Radiology
      Chicago, Illinois, United States
    • China Medical University Hospital
      • Department of Radiology
      臺中市, Taiwan, Taiwan
    • University of North Carolina at Chapel Hill
      North Carolina, 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
    • University of Toledo
      • Department of Surgery
      Toledo, Ohio, United States
    • University of Maryland, Baltimore
      • Department of Surgery
      Baltimore, Maryland, United States
    • The University of Tennessee Medical Center at Knoxville
      • Department of Surgery
      Knoxville, Tennessee, United States
  • 2011-2013
    • University of Texas at Dallas
      Richardson, Texas, 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
    • Urology Centers of Alabama
      Homewood, Alabama, United States
    • Medical College of Wisconsin
      • Department of Urology
      Milwaukee, Wisconsin, United States
    • Mansoura University
      • Urology and Nephrology Center
      El-Manṣûra, Muḩāfaz̧at ad Daqahlīyah, Egypt
  • 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
  • 1989-1994
    • Tripler Army Medical Center
      Honolulu, Hawaii, United States