Oxford Handbook of Urology

by Reynard, John; Brewster, Simon; Biers, Suzanne

• ISBN13: 9780198530954
• ISBN10: 0198530951
• Format: Paperback
• Copyright: 2005-12-22
• Publisher: Oxford University Press

Summary

Approximately 20% of all surgical operations and a similar percentage of surgical emergencies are urological in nature. However, often doctors have very limited experience of the many common and varied conditions encountered in this important surgical specialty. For the doctor or nurseexpected to provide the initial assessment and management of a condition with which he or she has had very limited experience, this book provides an invaluable source of information and advice. This applies not only to SHOs and specialist registrars on urology and surgical rotations, but also toGeneral Practitioners, Accident and Emergency staff and the growing number of urological specialist nurses. This handbook provides a comprehensive summary of urological disease and its management, in a form that is concise, relevant to the target audience and readily available. While the description of urological conditions is comprehensive, the emphasis is on the practical approach to the conditionswhich are likely to be encountered. The significance and appropriate management of common symptoms is described, providing (on a single page) a summary of the essential approach to a specific presenting complaint, be that haematuria, scrotal pain or bedwetting. Common urological operations are described, to allow the General Practitioner, Accident and Emergency doctor, nurse or surgical trainee, rapid access to information concerning indications, pre-operative assessment, consent, and complications and their management.

Author Biography

Suzanne Biers is Research Registrar in Urology, Department, of Urology, Churchill Hospital, Oxford, UK.

Table of Contents

General principles of management of patients	p. 1
Communication skills	p. 2
Documentation and notekeeping	p. 4
Patient safety in surgical practice	p. 6
Significance and preliminary investigation of urological symptoms and signs	p. 7
Haematuria I: definition and types	p. 8
Haematuria II: causes and investigation	p. 10
Haemospermia	p. 12
Lower urinary tract symptoms (LUTS)	p. 14
Nocturia and nocturnal polyuria	p. 18
Loin (flank) pain	p. 20
Urinary incontinence	p. 24
Genital symptoms	p. 26
Abdominal examination in urological disease	p. 28
Digital rectal examination (DRE)	p. 32
Lumps in the groin	p. 34
Lumps in the scrotum	p. 36
Urological investigations	p. 39
Urine examination	p. 40
Urine cytology	p. 42
Prostatic specific antigen (PSA)	p. 44
Radiological imaging of the urinary tract	p. 46
Uses of plain abdominal radiography	p. 48
Intravenous urography (IVU)	p. 50
Other urological contrast studies	p. 54
Computed tomography (CT) and magnetic resonance imaging (MRI)	p. 56
Radioisotope imaging	p. 58
Uroflowmetry	p. 60
Post-void residual urine volume measurement	p. 64
Cystometry, pressure flow studies, and videocystometry	p. 66
Bladder outlet obstruction	p. 69
Regulation of prostate growth and development of benign prostatic hyperplasia (BPH)	p. 70
Pathophysiology and causes of bladder outlet obstruction (BOO) and BPH	p. 72
Benign prostatic obstruction (BPO): symptoms and signs	p. 74
Diagnostic tests in men with LUTS thought to be due to BPH	p. 76
Why do men seek treatment for their symptoms?	p. 78
Watchful waiting for uncomplicated BPH	p. 80
Medical management of BPH: alpha blockers	p. 82
Medical management of BPH: 5[alpha]-reductase inhibitors	p. 84
Medical management of BPH: combination therapy	p. 86
Medical management of BPH: alternative drug therapy	p. 87
Minimally invasive management of BPH: surgical alternatives to TURP	p. 88
Invasive surgical alternatives to TURP	p. 90
TURP and open prostatectomy	p. 92
Acute urinary retention: definition, pathophysiology, and causes	p. 94
Acute urinary retention: initial and definitive management	p. 98
Indications for and technique of urethral catheterization	p. 100
Indications for and technique of suprapubic catheterization	p. 102
Management of nocturia and nocturnal polyuria	p. 104
High pressure chronic retention (HPCR)	p. 106
Bladder outlet obstruction and retention in women	p. 108
Urethral stricture disease	p. 110
Incontinence	p. 113
Classification	p. 114
Causes and pathophysiology	p. 116
Evaluation	p. 118
Treatment of sphincter weakness incontinence: injection therapy	p. 119
Treatment of sphincter weakness incontinence: retropubic suspension	p. 120
Treatment of sphincter weakness incontinence: pubovaginal slings	p. 121
Treatment of sphincter weakness incontinence: the artificial urinary sphincter	p. 122
Overactive bladder: conventional treatment	p. 124
Overactive bladder: options for failed conventional therapy	p. 125
'Mixed' incontinence	p. 126
Post-prostatectomy incontinence	p. 128
Vesicovaginal fistula (VVF)	p. 130
Incontinence in the elderly patient	p. 132
Infections and inflammatory conditions	p. 135
Urinary tract infection: definitions, incidence, and epidemiology	p. 136
Urinary tract infection: microbiology	p. 138
Lower urinary tract infection	p. 142
Recurrent urinary tract infection	p. 144
Urinary tract infection: treatment	p. 148
Acute pyelonephritis	p. 150
Pyonephrosis and perinephric abscess	p. 152
Other forms of pyelonephritis	p. 154
Chronic pyelonephritis	p. 156
Septicaemia	p. 158
Fournier's gangrene	p. 162
Epididymitis and orchitis	p. 164
Peri-urethral abscess	p. 166
Prostatitis: epidemiology and classification	p. 168
Prostatitis: presentation, evaluation, and treatment; prostatic abscess	p. 170
Interstitial cystitis	p. 172
Tuberculosis	p. 174
Parasitic infections	p. 176
HIV and hepatitis in urological surgery	p. 178
Phimosis	p. 182
Inflammatory disorders of the penis	p. 184
Urological neoplasia	p. 187
Molecular biology and pathology	p. 190
Prostate cancer: epidemiology and aetiology	p. 192
Prostate cancer: incidence, prevalence, and mortality	p. 194
Prostate cancer pathology: adenocarcinoma	p. 195
Prostate cancer pathology: possible premalignant lesions	p. 196
Prostatic specific antigen (PSA) and prostate cancer screening	p. 197
Prostate cancer: clinical presentation	p. 198
PSA and prostate cancer	p. 200
PSA derivatives: free-to-total ratio, density, and velocity	p. 202
Counselling before PSA testing	p. 203
Prostate cancer: transrectal ultrasonography and biopsies	p. 204
Prostate cancer staging	p. 208
Prostate cancer grading	p. 216
Management of localized prostate cancer: watchful waiting	p. 218
Management of localized prostate cancer: radical prostatectomy	p. 220
Post-operative course after radical prostatectomy: complications	p. 222
Prostate cancer control with radical prostatectomy	p. 224
Management of localized prostate cancer: radical external beam radiotherapy (EBRT)	p. 226
Management of localized prostate cancer: brachytherapy (BT)	p. 228
Management of localized and radio-recurrent prostate cancer: cryotherapy and HIFU	p. 230
Management of locally advanced non-metastatic prostate cancer (T3-4 N0M0)	p. 231
Management of advanced prostate cancer: hormone therapy I	p. 232
Management of advanced prostate cancer: hormone therapy II	p. 234
Management of advanced prostate cancer: hormone therapy III	p. 236
Management of advanced prostate cancer: androgen-independent disease	p. 238
Palliative management of prostate cancer	p. 240
Prostate cancer: prevention; complementary and alternative therapies	p. 242
Bladder cancer: epidemiology and aetiology	p. 244
Bladder cancer: pathology and staging	p. 246
Bladder cancer: presentation	p. 250
Bladder cancer: diagnosis and staging	p. 252
Management of superficial TCC: transurethral resection of bladder tumour (TURBT)	p. 254
Management of superficial TCC: adjuvant intravesical chemotherapy and BCG	p. 256
Muscle-invasive bladder cancer: surgical management of localized (pT2/3a) disease	p. 258
Muscle-invasive bladder cancer: radical and palliative radiotherapy	p. 260
Muscle-invasive bladder cancer: management of locally advanced and metastatic disease	p. 262
Bladder cancer: urinary diversion after cystectomy	p. 264
Transitional cell carcinoma (TCC) of the renal pelvis and ureter	p. 268
Radiological assessment of renal masses	p. 272
Benign renal masses	p. 274
Renal cell carcinoma: epidemiology and aetiology	p. 276
Renal cell carcinoma: pathology, staging, and prognosis	p. 278
Renal cell carcinoma: presentation and investigations	p. 282
Renal cell carcinoma: surgical treatment I	p. 284
Renal cell carcinoma: surgical treatment II	p. 286
Renal cell carcinoma: management of metastatic disease	p. 288
Testicular cancer: epidemiology and aetiology	p. 290
Testicular cancer: clinical presentation	p. 292
Testicular cancer: serum markers	p. 294
Testicular cancer: pathology and staging	p. 296
Testicular cancer: prognostic staging system for metastatic germ cell cancer	p. 300
Testicular cancer: management of non-seminomatous germ cell tumours (NSGCT)	p. 302
Testicular cancer: management of seminoma, IGCN, and lymphoma	p. 304
Penile neoplasia: benign, viral-related, and premalignant lesions	p. 306
Penile cancer: epidemiology, risk factors, and pathology	p. 308
Squamous cell carcinoma of the penis: clinical management	p. 312
Carcinoma of the scrotum	p. 314
Tumours of the testicular adnexa	p. 315
Urethral cancer	p. 316
Retroperitoneal fibrosis	p. 320
Wilms' tumour and neuroblastoma	p. 322
Miscellaneous urological disease of the kidney	p. 325
Cystic renal disease: simple cysts	p. 326
Cystic renal disease: calyceal diverticulum	p. 328
Cystic renal disease: medullary sponge kidney (MSK)	p. 330
Acquired renal cystic disease (ARCD)	p. 332
Autosomal dominant (adult) polycystic kidney disease (ADPKD)	p. 334
Vesicoureteric reflux (VUR) in adults	p. 336
Pelviureteric junction (PUJ) obstruction in adults	p. 340
Anomalies of renal ascent and fusion: horseshoe kidney, pelvic kidney, malrotation	p. 342
Renal duplications	p. 346
Stone disease	p. 349
Kidney stones: epidemiology	p. 350
Kidney stones: types and predisposing factors	p. 352
Kidney stones: mechanisms of formation	p. 354
Factors predisposing to specific stone types	p. 356
Evaluation of the stone former	p. 358
Kidney stones: presentation and diagnosis	p. 362
Kidney stones treatment options: watchful waiting	p. 364
Stone fragmentation techniques: extracorporeal lithotripsy (ESWL)	p. 366
Intracorporeal techniques of stone fragmentation	p. 368
Kidney stone treatment: flexible ureteroscopy and laser treatment	p. 372
Kidney stone treatment: percutaneous nephrolithotomy (PCNL)	p. 374
Kidney stones: open stone surgery	p. 378
Kidney stones: medical therapy (dissolution therapy)	p. 380
Ureteric stones: presentation	p. 382
Ureteric stones: diagnostic radiological imaging	p. 384
Ureteric stones: acute management	p. 386
Ureteric stones: indications for intervention to relieve obstruction and/or remove the stone	p. 388
Ureteric stone treatment	p. 390
Treatment options for ureteric stones	p. 392
Prevention of calcium oxalate stone formation	p. 394
Bladder stones	p. 396
Management of ureteric stones in pregnancy	p. 398
Upper tract obstruction, loin pain, hydronephrosis	p. 401
Hydronephrosis	p. 402
Management of ureteric strictures (other than PUJO)	p. 406
Pathophysiology of urinary tract obstruction	p. 410
Physiology of urine flow from kidneys to bladder	p. 412
Ureter innervation	p. 414
Trauma to the urinary tract and other urological emergencies	p. 415
Renal trauma: classification, mechanism, grading	p. 416
Renal trauma: clinical and radiological assessment	p. 420
Renal trauma: treatment	p. 422
Ureteric injuries: mechanisms and diagnosis	p. 426
Ureteric injuries: management	p. 428
Pelvic fractures; bladder and ureteric injuries associated with pelvic fractures	p. 432
Bladder injuries	p. 438
Posterior urethral injuries in males and urethral injuries in females	p. 442
Anterior urethral injuries	p. 444
Testicular injuries	p. 448
Penile injuries	p. 450
Torsion of the testis and testicular appendages	p. 452
Paraphimosis	p. 454
Malignant ureteric obstruction	p. 456
Spinal cord and cauda equina compression	p. 457
Infertility	p. 459
Male reproductive physiology	p. 460
Aetiology and evaluation of male infertility	p. 464
Investigation of male infertility	p. 466
Oligospermia and azoospermia	p. 468
Varicocele	p. 470
Treatment options for male factor infertility	p. 472
Disorders of erectile function, ejaculation, and seminal vesicles	p. 475
Physiology of erection and ejaculation	p. 476
Impotence: evaluation	p. 480
Impotence: treatment	p. 482
Retrograde ejaculation	p. 484
Peyronie's disease	p. 486
Priapism	p. 488
Neuropathic bladder	p. 491
Innervation of the lower urinary tract (LUT)	p. 492
The physiology of urine storage and micturition	p. 496
Bladder and sphincter behaviour in the patient with neurological disease	p. 498
The neuropathic lower urinary tract: the clinical consequences of storage and emptying problems	p. 500
Bladder management techniques for the neuropathic patient	p. 502
Catheters and sheaths and the neuropathic patient	p. 506
Management of incontinence in the neuropathic patient	p. 508
Management of recurrent urinary tract infections (UTIs) in the neuropathic patient	p. 510
Management of hydronephrosis in the neuropathic patient	p. 512
Bladder dysfunction in multiple sclerosis, in Parkinson's disease, after stroke, and in other neurological disease	p. 514
Neuromodulation in lower urinary tract dysfunction	p. 516
Urological problems in pregnancy	p. 517
Physiological and anatomical changes in the urinary tract	p. 518
Urinary tract infection (UTI)	p. 520
Hydronephrosis	p. 522
Paediatric urology	p. 523
Embryology: urinary tract	p. 524
Undescended testes	p. 526
Urinary tract infection (UTI)	p. 528
Vesicoureteric reflux (VUR)	p. 530
Ectopic ureter	p. 532
Ureterocele	p. 533
Pelviureteric junction (PUJ) obstruction	p. 534
Hypospadias	p. 536
Normal sexual differentiation	p. 538
Abnormal sexual differentiation	p. 540
Cystic kidney disease	p. 544
Exstrophy	p. 546
Epispadias	p. 547
Posterior urethral valves (PUVs)	p. 548
Non-neurogenic voiding dysfunction	p. 550
Nocturnal enuresis	p. 552
Urological surgery and equipment	p. 555
Preparation of the patient for urological surgery	p. 556
Antibiotic prophylaxis in urological surgery	p. 558
Complications of surgery in general: DVT and PE	p. 562
Fluid balance and the management of shock in the surgical patient	p. 566
Patient safety in the urology theatre	p. 568
Transurethral resection (TUR) syndrome	p. 570
Catheters and drains in urological surgery	p. 572
Guidewires	p. 578
Irrigating fluids and techniques of bladder washout	p. 580
JJ stents	p. 582
Lasers in urological surgery	p. 588
Diathermy	p. 590
Sterilization of urological equipment	p. 592
Telescopes and light sources in urological endoscopy	p. 594
Consent: general principles	p. 596
Cystoscopy	p. 598
Transurethral resection of the prostate (TURP)	p. 600
Transurethral resection of bladder tumour (TURBT)	p. 602
Optical urethrotomy	p. 604
Circumcision	p. 606
Hydrocele and epididymal cyst removal	p. 608
Nesbit's procedure	p. 610
Vasectomy and vasovasostomy	p. 612
Orchidectomy	p. 614
Urologocial incisions	p. 616
JJ stent insertion	p. 618
Nephrectomy and nephroureterectomy	p. 620
Radical prostatectomy	p. 622
Radical cystectomy	p. 624
Ileal conduit	p. 628
Percutaneous nephrolithotomy (PCNL)	p. 630
Ureteroscopes and ureteroscopy	p. 634
Pyeloplasty	p. 638
Laparoscopic surgery	p. 640
Endoscopic cystolitholapxy and (open) cystolithotomy	p. 642
Scrotal exploration for torsion and orchidopexy	p. 644
Basic science of relevance to urological practice	p. 647
Physiology of bladder and urethra	p. 648
Renal anatomy: renal blood flow and its regulation	p. 650
Renal physiology: regulation of water balance	p. 654
Renal physiology: regulation of sodium and potassium excretion	p. 655
Renal physiology: acid-base balance	p. 656
Urological eponyms	p. 659
Index	p. 665
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