In one month, a survey response rate of more than 50% was obtained by leveraging the increased adoption of mobile phones in rural settings. Nearly all patients/families treated during the cleft mission were satisfied with the care that they received.

Patients undergoing aorto-iliac operations frequently suffer severe physical and psychological problems as a consequence of postoperative sexual disability. In an attempt to reduce this symptom complex, careful preoperative and postoperative evaluations were performed on 20 patients undergoing such procedures. Their average age was 64 years. Patients were divided into groups distinguished by type of operative procedure and extent of sexual function, then carefully evaluated for changes related to technical aspects of the vascular reconstruction. Data were accumulated pertaining to preoperative and postoperative frequency of sexual intercouse, ability to achieve and maintain an erection, occurrence of retrograde ejaculation, and other symptoms of genitourinary dysfunction. Significant and disabling sexual dysfunction, found to occur after routine abdominal aneurysmectomy, aorto-femoral bypass grafting, and aorto-iliac endarterectomy, is believed to be related to type of operation and technical aspects of the procedure. The incidence of postoperative retrograde ejaculation and impotence was significant.

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Although abundantly documented in the literature, it perhaps takes a certain amount of effort to disavow oneself of the stereotype prejudices regarding the significance of sexual disability as related to age. It has become quite evident that advanced age does not mitigate the difficulties of psychological adjustment to postoperative sexual disability.On August 2, 1972, an 80-year-old man was admitted to UCLA Hospital for hypotension, severe abdominal pain, a large pulsatile abdominal mass, and reduced peripheral pulses in his lower extremities. At an emergency exploratory laparotomy, the patient was found to have a large retroperitoneally ruptured abdominal aortic aneurysm. He underwent abdominal aneurysmectomy and replacement with a Dacron tube graft. He made an uneventful recovery and was discharged from the hospital on the tenth postoperative day. During the third postoperative week, the patient was seen in follow-up examination, and aside from mild constipation, he had one severe complaint, that of retrograde ejaculation. When it became clear that we were ignorant as to the magnitude of the problem, its specific cause, or its possible solution, a cursory survey was undertaken that indicated that many patients undergoing aorto-iliac operations frequently suffer severe physical and psychological difficulties as a consequence of postoperative sexual disability. Most frequently encountered problems were impotence and retrograde ejaculation.To evaluate these problems in more detail, 20 consecutive patients who had undergone abdominal aortic operations were selected for study. These male patients ranged in age from 53 to 88 years with an average age of 64 years. Each was available for detailed postoperative evaluation and questioning and had sufficiently detailed operative records and annotations to make anatomical review complete. Careful documentation was obtained as to preoperative and postoperative ability to achieve and maintain erection, retrograde ejaculation, the frequency of sexual intercourse, and urinary tract symptoms. Operative records were reviewed and surgeons interviewed to establish levels and extent of' dissection, levels of vascular control, type of operation performed, use of an indwelling urethral catheter, and performance of lumbar sympathectomy. Three groups of patients were identified: those undergoing aorto-iliac endarterectomy, 3 patients; those undergoing aorto-femoral bypass, 5 patients; and those undergoing abdominal aortic aneurysmectomy, 12 patients. Average age of the patients undergoing aorto-iliac endarterectomy

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