PENN Clinical Manual of Urology, 3rd Edition

cover
Front matter
Penn Clinical Manual of Urology
Copyright
Dedication
Contributors
Preface
Contents
1 Signs and symptoms: The initial examination
Background
Definition
Importance to other branches of medicine
Urologic manifestations of disease
Direct
Referred manifestations
Systemic
Asymptomatic
History
Symptoms
Pain
Alterations of micturition
Changes in the gross appearance of the urine
Abnormal appearance and function of the male external genitalia
The physical examination
General information
Kidneys and flanks
Abdomen and bladder
Penis
Scrotum and scrotal contents
The rectum and prostate
The vaginal examination
The urinalysis and culture
Collection
Physical aspects of urine
Dipstick tests
Microscopic examination
Urine culture
Initial point-of-care imaging
Ultrasound
Bladder scanning
Blood tests
Panel 7 (or similar designation)
PSA level
Summary
Self-assessment questions
Suggested readings
2 Diagnostic and interventional uroradiology
Diagnostic uroradiology
Plain films (kidney, ureters, and bladder plain radiography)
Indications
Ultrasonography
Technique
Indications for US examination in the urinary tract
Kidneys
Ureter
Urinary bladder
Prostate and seminal vesicles
Scrotum and external genitalia
Pitfalls of ultrasound
Computed tomography
Basic principles
Technique
Indications
Renal
Renal mass evaluation
Hematuria
Urolithiasis
Trauma
Urinary bladder
Bladder carcinoma
Trauma
Prostate and seminal vesicles
Adrenal gland
Pitfalls of computed tomography evaluation
Magnetic resonance imaging
Basic principles
Complications
Indications for magnetic resonance imaging
Renal
Bladder
Prostate
Adrenal glands
Pitfalls
Intravenous urography
Indications
Radiographic iodinated contrast agents
Retrograde pyeloureterography
Indications
Contraindications
Techniques
Complications
Antegrade pyelography
Indications
Contraindications
Technique
Complications
Cystography
Indications
Contraindications
Technique
Complications
Modifications of cystography
Computed tomography cystogram
Voiding cystourethrogram
Indications
Contraindications
Techniques
Complications
Retrograde urethrogram
Purpose
Indications
Contraindications
Technique
Complications
Loopogram and pouchogram
Indications
Contraindications
Technique
Complications
Angiography
Indications for renal arteriography
Indications for adrenal gland angiography
Indications for gonadal phlebography
Radionuclide imaging
Indications
Contraindications
Technique
Complications
Interventional uroradiology
Percutaneous nephrostomy
Indications for PCN
Preprocedural evaluation prior to PCN
Contraindications to PCN
Technique
Results
Complications
Percutaneous nephrostomy for nonobstructive indications
Management of upper urinary tract calculi
Technique for percutaneous nephrostolithotomy
Contraindications
Complications
Treatment of ureteral calculi
Other procedures performed through a PCN access track
Ureteral stenting
Principles
Indications
Contraindications
Technique
Results
Complications
Dilation of ureteral and urethral stenoses
Principles
Indications
Contraindications
Technique
Results
Complications
Percutaneous drainage of renal and related retroperitoneal fluid collections
Principles
Indications
Contraindications
Technique
Results
Complications
Percutaneous drainage of lymphoceles
Percutaneous drainage of urinomas
Renal cyst aspiration and ablation
Indications
Contraindications
Technique
Results
Complications
Urinary tract biopsy techniques
Indications
Contraindications
Technique
Results
Complications
Image-guided ablation of renal tumors
Radiofrequency ablation
Cryoablation
Self-assessment questions
Suggested readings
3 Lower urinary tract infections in women and pyelonephritis
Lower urinary tract infection
Definition
Classification schema
Epidemiology
Pathophysiology
Differential diagnosis: Signs and symptoms, diagnostic studies
Therapy: General considerations
Uncomplicated isolated cystitis
Recurrent urinary tract infection
Choice of antibiotic
Catheter-associated urinary tract infection
Asymptomatic bacteriuria
Pyelonephritis
Clinical presentation
Complications
Management (Fig. 3.4)
Self-assessment questions
Suggested readings
4 Lower urinary tract infection in males
Introduction
Incidence and epidemiology
Etiology, pathophysiology, bacterial organisms
Bacterial cystitis
Diagnosis
Management
Prostatitis
Incidence
Etiology and risk factors
Classification and diagnosis
Category I: Acute bacterial prostatitis
Prostatic abscess
Category II: Chronic bacterial prostatitis
Category IIIA/IIIB: Chronic nonbacterial prostatitis/chronic pelvic pain syndrome
Category IV: Asymptomatic inflammatory prostatitis
Epididymitis and orchitis
Epididymitis
Etiology and risk factors
Diagnosis
Treatment
Orchitis
Antibiotic addendum
Self-assessment questions
Suggested readings
5 Specific infections of the genitourinary tract
Genitourinary tuberculosis
Epidemiology
Pathogenesis
Presentation and diagnosis
Management
Genitourinary schistosomiasis
Epidemiology
Pathogenesis
Presentation and diagnosis
Management
Genitourinary fungal infections
General considerations
Candidiasis
Aspergillosis
Cryptococcosis
Rare parasitic genitourinary infections
Hydatid disease (echinococcus)
Amebiasis
Other genitourinary infections
Genital filariasis
Fournier’s gangrene
Self-assessment questions
Suggested readings
6 Sexually transmitted infections
Introduction
Bacterial urethritis
Diagnosis
Gonorrhea
Treatment of uncomplicated gonococcal urethritis
Recommended regimens
Follow-up
Complications
Chlamydia
Treatment
Recurrent and persistent infections
Nonchlamydial nongonococcal urethritis
Epididymitis
Diagnosis
Treatment
Genital lesions
Condyloma acuminata (genital warts)
Treatment
Recommended regimens for external genital warts
Surgical removal for very large wart burden
Genital ulcers
Genital herpes
Treatment
First clinical episode of genital herpes
Episodic therapy for recurrent genital herpes
Suppressive therapy for recurrent genital herpes
Severe disease
Pregnancy and HSV
Syphilis
Primary syphilis
Secondary syphilis
Latent syphilis
Tertiary gummatous syphilis
Diagnosis
Treatment
Chancroid
Diagnosis
Treatment
Lymphogranuloma venereum
Treatment
Granuloma inguinale
Treatment
Molluscum contagiosum
Treatment
Vaginitis
Bacterial vaginosis
Treatment
Trichomoniasis
Treatment
Vulvovaginal candidiasis
Treatment
Ectoparasites
Phthirus pubis
Viral hepatitis
Hepatitis B
Diagnosis
Screening
Prevention
Postexposure
Hepatitis C
Diagnosis
Treatment
Zika virus
Symptoms
Diagnosis
Preconception counseling and prevention
Human immunodeficiency virus
Malignancies
Impotence
Voiding dysfunction
Self-assessment questions
Suggested readings
7 Interstitial cystitis/bladder pain syndrome
Definition
The hunner lesion
Epidemiology
Etiology
Diagnosis
Initial management
Oral therapy
Intravesical therapy
Hydrodistention
Neuromodulation
Surgical therapy
Philosophy of management
Suggested readings
8 Urolithiasis in the adult
Epidemiology
Composition of renal stones
Pathogenesis and physiochemical properties
Genetics
Environmental
Physical and biochemical properties of stone formation
Pathophysiology of stone formation
Stone formation and vascular calcification
Clinical manifestations of nephrolithiasis
Presentation
Evaluation of patients with nephrolithiasis (Fig. 8.1)
Management of nephrolithiasis
Medical therapy (Table 8.2)
Acute renal colic
Surgical therapy
Additional counseling considerations
Follow-up
Quality of life
Recurrence
Self-assessment questions
References
Suggested readings
9 Penn clinical manual chapter on urologic emergencies
Introduction
Gross hematuria
Workup
Management
Catheter selection recommendations
How to irrigate
Acute urinary retention
History
Physical exam
Labs
Imaging
Differential diagnosis
Management
Difficult catheterization
History
Planning
Issues with indwelling foley drainage
History
Physical exam
Differential diagnosis
Management
Flank pain and upper tract obstruction
Differential diagnosis
Symptoms
Other history
Physical exam
Labs
Imaging
Indications for urologic intervention
Management (short term)
General principles
Postobstructive diuresis
Diagnosis
Management
Oliguria/anuria (AKI)
Definitions
History
Physical exam
Laboratory studies
Imaging
Differential diagnosis
Management
Acute scrotum
Differential diagnosis of acute scrotal pain
History
Physical exam
Labs
Imaging
Management
Emergent urologic infections
Determine stability
History
Physical exam
Labs
Risk scores
Imaging
Management
Pyocele
Presentation
Management
Scrotal abscess
Presentation
Management
Emphysematous cystitis
Presentation
Management
Emphysematous pyelitis vs emphysematous pyelonephritis
Presentation
Management
Perinephric or renal abscess
Priapism
Classification
Ischemic
Nonischemic
Stuttering
History
Physical exam
Laboratory data
Imaging
Differential diagnosis of etiology
Treatment
Management of ischemic priapism
Management of nonischemic priapism
Penile fracture
History
Physical exam
Laboratory
Imaging
Management
Foreskin
Management
Foreign bodies
Zipper injuries
External ring injuries
Intraurethral foreign bodies
Spinal cord compression
Presentation
Evaluation
Management
Self-assessment questions
Suggested readings
10 Urinary and genital trauma
Introduction
Kidney injuries
Initial evaluation
Injury classification
Management
Operative management
Complications
Ureteral injuries
Initial evaluation
Management
Operative management
Proximal ureter
Mid ureter
Distal ureter
Complications
Bladder injuries
Initial evaluation
Management
Extraperitoneal injuries
Intraperitoneal injuries
Complications
Urethral injuries
Mechanisms
Initial evaluation
Management
Posterior urethra
Anterior urethra
Follow-up care
Injuries to the male external genitalia
Mechanisms of penile injury
Penile fracture
Operative management
Penetrating trauma to the penis
Operative management
Penile amputation
Operative management
Testicular injuries
Genital skin injuries
Scrotal injuries
Genital bite wounds
Genital burns
Injuries to the female genitalia
Mechanisms
Management
Conclusions
Self-assessment questions
Suggested readings
11 Urethral stricture and lower urinary tract reconstruction
Introduction
Etiologies
Urethral anatomy
Clinical evaluation
History
Physical examination
Diagnostic studies
Retrograde urethrogram technique
Preoperative evaluation and optimization
Suprapubic tube placement technique
Operative management
Anterior urethral strictures
Endoscopic management
Urethroplasty and surgical options
Excision and primary anastomosis
Brief technique
Substitution urethroplasty
Brief technique
Distal anterior urethral strictures
Augmented anastomotic repair
Brief technique
Nontransecting repairs
Brief technique
Multistage urethroplasty
Perineal urethrostomy
Brief technique
Posterior urethral stenosis
Pelvic fracture urethral distraction defects
Brief technique
Radiation-induced stenosis
Bladder neck contractures/vesicourethral anastomotic stenosis
Rectourethral fistula
Brief technique
Devastated urethras or outlets
Complications of urethral stricture management
Female urethral strictures
Work-up
Management
Self-assessment questions
Suggested readings
12 Urinary fistula
Vesicovaginal fistula
General considerations
Etiology
Presentation
Evaluation (Fig. 12.2)
Therapy
Ureterovaginal fistula
Etiology
Presentation
Evaluation
Therapy
Urethrovaginal fistula
Etiology
Presentation
Evaluation
Therapy
Enterovesical fistula
General considerations
Etiology
Presentation
Evaluation
Therapy
Rectourethral fistula
Etiology
Presentation
Evaluation
Therapy
Other urinary fistula
Urovascular fistula
Vesicouterine fistula
Self-assessment questions (correct answer is bold)
Suggested readings
13 Nocturia
Introduction
Epidemiology
Prevalence
Incidence
Nocturia and bother
Beyond bother: Nocturia and quality of life, morbidity, and mortality
Causes of nocturia
Initial evaluation of nocturia
The clinical assessment
Medical/symptom history
The voiding diary
Interpreting the voiding diary
Specific voiding diary–derived diagnoses
Nocturnal polyuria
Global polyuria
Small bladder storage capacity
Mixed nocturia
Further voiding diary–based characterization of nocturia
Nocturia severity
Degree of production-storage mismatch
Early hours of sleep
Treatment
Trends in treatment
Self-assessment questions
Suggested readings
14 Lower urinary tract function and dysfunction; urinary incontinence
Introduction
Relevant lower urinary tract anatomy, physiology, pharmacology, and terminology
Bladder, urethra, smooth and striated sphincter
Innervation and receptor function
CNS influences on micturition
Normal lower urinary tract function
What determines bladder response during filling/storage?
What determines outlet response during filling/storage?
Why does voiding ensue with a normal bladder contraction?
Why does urinary continence persist during abdominal pressure increases?
Overview of the micturition cycle: Simplification and summary
Abnormalities of filling/storage and emptying/voiding: Overview of pathophysiology (Tables 14.3 and 14.4)
Filling/storage failure
Emptying/voiding failure
The neurourologic evaluation (Table 14.5)
History
Physical and neurologic evaluation
Radiologic evaluation
Endoscopic evaluation
Urodynamic and video urodynamic evaluation
Classification of lower urinary tract dysfunction
The functional system
International continence society classification
Lapides classification
Neurogenic lower urinary tract dysfunction
General patterns
Common nonneurogenic lower urinary tract dysfunctions
Urinary incontinence
Treatment of lower urinary tract dysfunction
General principles
Therapy to facilitate bladder filling/urine storage
Therapy to facilitate bladder emptying and voiding
Suggested readings
15 Benign prostatic hyperplasia and related entities
General considerations
Definitions and epidemiology
Prostatic size and morphology pertinent to benign prostatic hyperplasia
Etiologic theories of benign prostatic hyperplasia: Pathophysiology
Hormones
Stromal-epithelial interaction theory
Stem cell theory
Static and dynamic components of prostatic obstruction
Lower urinary tract symptoms
Signs of benign prostatic hyperplasia
Urodynamics of bladder outlet obstruction
Residual urine volume
Uroflowmetry
Cystometry and pressure flow studies
Symptomatic versus urodynamic improvement
The natural history of benign prostatic hyperplasia and its alteration
Evaluation of lower urinary tract symptoms suspected to be due to benign prostatic hyperplasia
Symptoms and symptom scores
Quality-of-life indices
Indications for treatment
Treatment of benign prostatic hyperplasia and related entities
Assessing the results of treatment
Watchful waiting
Alpha-adrenergic antagonists
5-alpha reductase inhibitors
Combined therapy
Anticholinergic agents
Complimentary and alternative medicine
Nonmedical management
Minimally invasive therapies: Thermal therapies
Transurethral microwave thermotherapy
Transurethral needle ablation of the prostate
Water vapor thermal therapy
Photoselective vaporization of the prostate
Holmium laser ablation of the prostate
Transurethral electrovaporization of the prostate
Minimally invasive nonthermal therapies: Nonthermal prostatic urethral lift
Transurethral electrosurgical incision of the bladder neck and prostate
Surgical procedures
Transurethral resection of the prostate
Holmium laser enucleation of the prostate
Holmium laser resection of the prostate
Aquablation
Open prostatectomy
Other therapies
Prostate stents
Prostate artery embolization
Conclusion
Self-assessment questions
16 Adult genitourinary cancer: Prostate and bladder
Prostate cancer
General considerations
Incidence
Prostate-specific antigen screening
Epidemiology
Etiology
Pathology
Grading and staging system
Signs and symptoms
Natural history
Diagnosis and staging/prostate-specific antigen screening
Cancer prevention
Outcome prognosis and stratification
Treatment of localized disease
Treatment of biochemical and clinical failure
Treatment of advanced disease
Carcinoma of the bladder
General considerations
Epidemiology
Etiology
Pathology
Grading and staging system
Natural history
Signs and symptoms
Diagnosis of bladder cancer
Disease screening and tumor markers
Clinical staging and imaging
Therapy in general
Treatment of low-grade ta disease
Treatment of high-grade ta disease and carcinoma in situ
Treatment of T1 disease
Cystoscopic schedule and upper urinary tract follow-up
Treatment of T2 and greater disease
Urinary diversion
Treatment of advanced disease
Self-assessment questions
Suggested readings
Prostate cancer
Bladder cancer
17 Adult genitourinary cancer: Renal and testicular
Neoplasms of the kidney
General considerations
Incidence and epidemiology
Etiology
Pathology: Renal tumors
Grading and staging
Clinical presentation
Imaging evaluation
Treatment
Follow-up after treatment
Urothelial tumors of the renal pelvis and ureter
General considerations
Incidence
Etiology and natural history
Clinical presentation
Pathology and staging
Diagnosis
Treatment of UTUCC
Testicular tumors
General comments
Incidence
Etiology
Epidemiology
Natural history
Pathology
Staging
Clinical presentation
Diagnosis and staging
Treatment after orchiectomy
Self-assessment questions
Suggested readings
Renal cell carcinoma
Upper tract urothelial cell carcinoma
Testicular cancer
18 Adult genitourinary cancer: Urethral and penile
Penile cancer
General considerations
NCCN surveillance recommendations by treatment and stage
Self-assessment questions
Urethral cancer
General considerations
Self-assessment question
19 Radiation therapy
Physics
Radiobiology
Treatment planning
Clinical radiation oncology
Renal pelvic and ureteral carcinoma
Bladder carcinoma
Prostate cancer
Testicular cancer
Penile and urethral cancers
Summary
Self-assessment questions
Suggested readings
20 Laparoscopic surgical anatomy, laparoscopy, and robotic-assisted laparoscopic surgery
Introduction
Patient selection
Relative contraindications
Chronic obstructive pulmonary disease
Pregnancy
Obesity
Prior abdominal surgery
Patient positioning
Renal surgery
Transperitoneal approach
Retroperitoneal approach
Robotic-assisted laparoscopic prostatectomy
Other pelvic and upper tract surgery
Access
Closed (veress) access
Open (hasson) access
Direct access and trocar types
Physiologic changes of pneumoperitoneum
Cardiovascular effects
Pulmonary effects
Renal effects
Trocar placement
Transperitoneal renal surgery
Retroperitoneal renal surgery
Hand-assisted laparoscopic renal surgery
Prostatectomy
Laparoendoscopic single-site surgery
Other upper tract and pelvic surgeries
Surgical anatomy of the upper urinary tract
Right renal surgery
Left renal surgery
Retroperitoneal renal surgery
Surgical anatomy of the lower urinary tract
Complications
Neuromuscular injuries
Vascular injuries during entry
Bowel injuries
CO₂ embolism
Self-assessment questions
Suggested readings
21 Male sexual dysfunction
Introduction
Peyronie’s disease
Burden of disease
Pathogenesis
Clinical presentation and evaluation
Treatment
Physiology of sexual function
Erection
Penile anatomy (Fig. 21.e1)
Ejaculatory dysfunction
Treatment of ejaculatory dysfunction
Pathophysiology of erectile dysfunction
Erectile dysfunction prevalence and medical risk factors
Classification of erectile dysfunction
Evaluation of sexual dysfunction
History
Medical history
Sexual history
Psychosexual history
Physical exam
Laboratory data
Special studies
Vascular evaluation
Neurologic evaluation
Nocturnal penile tumescence testing
Cardiovascular risk assessment
Treatment
Nonsurgical management of erectile dysfunction
Lifestyle
Psychosexual therapy
Testosterone therapy
Pharmacologic therapy for erectile dysfunction
PDE-5 inhibitors
Daily PDE-5 inhibitors and use of PDE-5 inhibitors for both BPH/LUTS and ED
Intraurethral agents
Intracavernosal injection
Vacuum constriction device
Surgical management of erectile dysfunction
Penile prosthesis surgery
Types of prostheses
Vascular procedures
Novel treatments in erectile dysfunction
Direct-to-consumer websites for evaluation and treatment of erectile dysfunction
Self-assessment questions
Suggested readings
22 Male fertility and sterility
Epidemiology
The problem
Reproductive anatomy and physiology
Embryology
Gross anatomy
Reproductive hormonal axis
Extrahypothalamic central nervous system
Hypothalamus: Gonadotropin-releasing hormone
Pituitary gland
Feedback mechanisms
The testes
Testicular transport
Epididymis
Vas deferens
Semen composition
Clinical evaluation of the subfertile male
Assessment
Timing of evaluation
AUA/ASRMguidelines regarding fertility
Spermatotoxicity
Fertility history
General medical history
Physical examination
Laboratory evaluation
Semen analyses
Endocrine evaluation
Genomic assessment
Imaging during infertility evaluation
Classification of abnormalities
Genetic syndromes
Testicular causes
Pituitary dysfunction
Extratesticular endocrine dysfunction
Developmental disorders
Varicoceles
Cryptorchidism
Ejaculatory dysfunction
Substance abuse
Surgery
Evaluation of the infertile male
All parameters normal
Azoospermia
Multiple abnormal parameters on the semen analysis
Isolated abnormal parameter on semen analysis
Treatment options
Empirical treatment of idiopathic male-factor infertility
Medical treatment for male infertility
Surgical management of male infertility
Assisted reproductive technology
Conclusion
Self-assessment questions
Suggested readings
23 Disorders of the adrenal gland
Adrenal anatomy
Overview
Vasculature
Arterial supply
Venous drainage
Innervation
Histologic structure
Embryology
Adrenal physiology
Adrenal cortex physiology
Adrenal medulla physiology
Adrenal disorders
Increased adrenal function
Decreased adrenal function
Abnormal adrenal function
Adrenal neoplasia
Evaluation of adrenal pathology in urologic practice
Imaging of adrenal masses
Biopsy of adrenal masses
Assessment of function of adrenal masses
Summary of surgical indications
Self-assessment questions
Suggested readings
24 Retroperitoneal tumors and retroperitoneal fibrosis
Retroperitoneal anatomy
Benign diseases of the retroperitoneum
Retroperitoneal fibrosis
Retroperitoneal hemorrhage
Pelvis lipomatosis
Myelolipoma
Leiomyoma
Malignant pathology of the retroperitoneum
Epidemiology and etiology
Pathology
Diagnosis
Staging
Surgery
Outcomes
Radiation and chemotherapy
Self-assessment questions
Suggested readings
25 Embryology and differences of sex development
Normal sexual development
DSD categories
46XX DSD
21α-hydroxylase (CYP21) deficiency
11β-hydroxylase (CYP11B1) deficiency
46XY DSD
Leydig cell aplasia/hypoplasia
Androgen biosynthesis defects
Star deficiency
3β-hydroxysteroid dehydrogenase deficiency
17α-hydroxylase and 17,20 lyase (CYP17) deficiency
17β-hydroxysteroid dehydrogenase deficiency
Cytochrome P450 oxidoreductase deficiency
5α-reductase deficiency
Androgen insensitivity syndromes
Persistent müllerian duct syndrome (hernia uteri inguinale)
Vanishing testis syndrome
46XX testicular DSD
Gonadal dysgenesis
Complete gonadal dysgenesis
Partial gonadal dysgenesis
Ovotesticular DSD
Other DSD
Mayer-Rokitansky-Küster-Hauser syndrome
Evaluation and management of ambiguous genitalia at birth
History and physical examination
Laboratory studies
Imaging
Treatment options and indications
46XX-CAH
46XY DSD
Gonadal dysgenesis
Ovotesticular DSD
Gender
Follow-up
Suggested readings
26 Congenital anomalies
Upper urinary tract
Abnormalities of the kidney
Cystic abnormalities of the kidneys
Collecting system abnormalities
Ureteral anomalies
Lower urinary tract
Exstrophy/epispadias—spectrum of anomalies
Urachus
Posterior urethral valves
Megalourethra
Miscellaneous
External genital malformations
Hypospadias
Cryptorchidism
Hernia/communicating hydrocele
Appendages
Cloacal dysgenesis/persistent cloaca
Cloaca anomaly
Vaginal atresia and vaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome)
Self-assessment questions
Suggested readings
27 Pediatric oncology
Wilms tumor
General
Diagnosis
Pathology
Additional renal tumors
Staging
Treatment
Surgical management of wilms tumor
Neuroblastoma
Genitourinary rhabdomyosarcoma
Pathology
Presentation
Evaluation
Staging
Treatment
Testis tumors
Classification
Diagnosis
Management
Prognosis
Self-assessment questions
Suggested readings
28 Pediatric urolithiasis
Pediatric nephrolithiasis
Presentation
Laboratory evaluation
Urinary metabolic abnormalities
Calcium
Oxalate
Citrate
Cystine
Uric acid
Imaging
Treatment
Stone prevention
Medications
Follow-up
References
Suggested readings
29 Pediatric voiding function and dysfunction
Basic embryology
Anatomy and physiology
The normal voiding cycle
Neonate and infant
Transitional phase
Maturation
The clinical manifestations of voiding dysfunction
Hinman syndrome
The clinical approach to the patient
History
Questions a consulting physician must consider
Self and family assessment tools
The physical examination
Observe the patient void
Laboratory testing
Imaging
Imaging that is less frequently indicated for voiding dysfunction
Urodynamic measurements
Treatment of dysfunctional voiding/elimination by category
Urinary tract infections
Infrequent voider
Constipation
Dysfunctional voiding with detrusor sphincter dyssynergia
Striated external sphincter dyssynergia
Internal sphincteric dyssynergia
Hinman syndrome
Nocturnal enuresis
Additional background
Treatments for nocturnal enuresis
Pharmacologic options for enuresis
Anticholinergic therapy in pediatric voiding dysfunction
Voiding dysfunction and vesicoureteral reflux
Diabetes insipidus
Self-assessment questions
Suggested readings
30 Transitional urology
Introduction
Our approach to transition
Spina bifida
Background
Upper tract protection
Lower tract management/continence
Sexual health/fertility
Multispecialty management
Exstrophy-epispadias complex
Background
Initial approach and long-term management
Infection
Continence
Renal preservation
Sexual function
Psychosocial concerns
Long-term consideration of complex urologic reconstruction
Complications of urologic reconstruction
Perforation
Metabolic complications
Urinary tract infections and stones
Malignancy
Hypospadias
Urinary function
Sexual function and recurrent chordee
Surgical considerations
Posterior urethral valves
Etiology
Bladder management
Renal function
Prune belly syndrome
Urologic issues in childhood cancer survivors
Infertility
Sexual health
Suggested readings
31 Geriatric urology
Urology and aging patients
Special aspects of approach to the geriatric patient
Initial evaluation
Therapeutic decisions
The perioperative period
Preoperative patient optimization
Perioperative problems
Self-assessment questions
Suggested readings
32 Quality and safety considerations in urology
Introduction: What is patient safety and quality improvement?
Medical error: Consequences and contributing factors
Consequences of medical error
Factors contributing to medical error
Creating safety culture in the workplace
Establishing a culture that supports patient safety
Addressing organizational infrastructure
Standardizing health care systems and improving reliability
Methods of patient safety investigation
Introduction
Root cause analysis
Morbidity and mortality conference
Safety event analysis
Safety reporting systems
Quality improvement: Principles and methods
Introduction
The model for improvement
Lean and six sigma
Conclusion
Suggested readings
33 Clinical research design and statistics
Research question
Errors in research
Study design
Cohort studies
Case-control studies
Cross-sectional studies
Clinical trials
Study population
Variables
Exposure
Outcome
Confounders
Types of variable
Statistical analysis
Sample size calculations
Type 1 and type 2 errors
Power
Sensitivity and specificity
Sensitivity
Specificity
Implementing the study
Suggested readings