Campbell–Walsh–Wein Urology

Campbell-Walsh Urology, 12th ed
Title Page
Copyright
Dedication
Preface
Contributors
Video Contents
Part I: Clinical Decision Making
Chapter 1: Evaluation of the Urologic Patient: History and Physical Examination
History
Overview
Chief Complaint
History of Present Illness
Pain
Renal Pain.
Ureteral Pain.
Vesicle Pain.
Prostatic Pain.
Penile Pain.
Scrotal Pain.
Narcotic Considerations.
Hematuria
Lower Urinary Tract Symptoms
Urinary Incontinence.
Stress Incontinence.
Urge Incontinence.
Mixed Urinary Incontinence.
Continuous Incontinence.
Pseudoincontinence.
Overflow Incontinence.
Functional Incontinence.
Enuresis.
Sexual Dysfunction
Erectile Dysfunction.
Loss of Libido.
Premature Ejaculation.
Failure to Ejaculate.
Anorgasmia.
Hematospermia
Pneumaturia
Urethral Discharge
Fevers and Chills
Constitutional Symptoms
Medical History
Performance Status
Past Surgical History
Medications
Allergies
Social History
Illicit Drug Use
Sexual Relations
Domestic Station
Occupation
Family History
Review of Systems
Physical Examination
Vital Signs
General Appearance
Kidneys
Bladder
Penis
Scrotum and Contents
Digital Rectal Examination
Pelvic Examination in the Female
Neurologic Examination
Special Populations
Children
Elderly
Transgender and Gender Nonbinary People
Conclusion
References
Chapter 2: Evaluation of the Urologic Patient: Testing and Imaging
Urinalysis
Collection of Urinary Specimens
Males
Females
Neonates and Infants
Physical and Gross Examination of Urine
Color
Turbidity
Chemical Examination of Urine
Specific Gravity and Osmolality
pH
Blood/Hematuria
Differential Diagnosis and Evaluation of Hematuria
Glomerular Hematuria
IgA Nephropathy (Berger Disease)
Nonglomerular Hematuria
Medical/Nonsurgical
Surgical
Proteinuria
Pathophysiology
Detection
Evaluation
Glucose and Ketones
Bilirubin and Urobilinogen
Leukocyte Esterase and Nitrite Tests
Urinary Sediment
Obtaining and Preparing the Specimen
Microscopy Technique
Cells
Casts
Crystals
Bacteria
Yeast
Parasites
Expressed Prostatic Secretions
Serum Laboratory Studies
Prostate-Specific Antigen
Urinary Markers
Additional Serum Studies
Office Diagnostic Procedures
Uroflowmetry and Ultrasound for Postvoid Residual
Cystometrography and Multichannel Urodynamic Studies
Cystourethoscopy
Radiologic Imaging
Ultrasonography
Computed Tomography and Magnetic Resonance Imaging
Intravenous Pyelogram and Plain Radiographs
Summary
References
Chapter 3: Urinary Tract Imaging: Basic Principles of CT, MRI, and Plain Film Imaging
Conventional Radiography
Physics
Radiation Management in Uroradiology
Relative Radiation Levels
Radiation Protection
Contrast Media
Adverse Reactions to Intravascular Contrast Media
Allergic-Like Reactions
Treatment of Contrast Reactions
Treatment: Mild Allergic-Like and Physiologic Reactions.
Treatment: Moderate Allergic-Like and Physiologic Reactions.
Treatment: Severe Allergic-Like and Physiologic Reactions.
Premedication
Corticosteroid Premedication.
Premedication Strategies.
Premedication Regimens.
Accelerated IV Premedication.
Delayed Contrast Reactions
Specific Contrast Considerations
Allergy.
Anxiety.
Asthma.
Beta-Blockers.
Cardiac Abnormalities.
Hyperthyroidism.
Myasthenia Gravis.
Pheochromocytoma.
Sickle Cell Trait and Disease.
Extravasation of Contrast Material.
Postcontrast Acute Kidney Injury.
Metformin and Iodinated Contrast.
Metformin and Gadolinium.
Magnetic Resonance Imaging Contrast Agents
Gadolinium
Nephrogenic Systemic Fibrosis
Intravenous Urography
Technique
Indications
Plain Abdominal Radiography
Technique
Indications
Limitations
Retrograde Pyelography
Technique
Indications
Limitations
Complications
Loopography
Technique
Indications
Retrograde Urethrography
Technique
Indications
Static Cystography
Technique
Indications
Limitations
Voiding Cystourethrogram
Technique
Indications
Limitations
Nuclear Scintigraphy
Diuretic Scintigraphy
Nuclear Medicine in Urologic Oncology
Whole-Body Bone Scan
Positron Emission Tomography
Kidney Cancer
Bladder Cancer
Prostate Cancer
Adrenal Cancer
Testis Cancer
Positron Emission Tomography Magnetic Resonance Imaging
Computed Tomography
Hounsfield Units
Urolithiasis
Cystic and Solid Renal Masses
Hematuria
Magnetic Resonance Imaging
Adrenal Magnetic Resonance Imaging
Adrenal Adenoma
Adrenal Cortical Carcinoma
Myelolipoma
Metastasis
Pheochromocytoma
Other Adrenal Lesions
Renal Magnetic Resonance Imaging
Upper Tract and Lower Tract Magnetic Resonance Imaging for Transitional Cell Carcinoma
Prostate Magnetic Resonance Imaging
T2-Weighted Imaging
Diffusion-Weighted Imaging/Apparent Diffusion Coefficient Maps
Dynamic Contrast-Enhanced Magnetic Resonance Imaging
Magnetic Resonance Spectroscopy
Multiparametric Magnetic Resonance Imaging
Magnetic Resonance Fusion-Guided Prostate Biopsy
Acknowledgments
References
Radiation Management in Uroradiology
Contrast Media
Retrograde Pyelography
Loopography
Static Cystography
Voiding Cystourethrogram
Nuclear Scintigraphy
Positron Emission Tomography (PET)
Computed Tomography
MRI Introduction
Adrenal MRI
Renal MRI
Upper and Lower Tract MRI
Prostate MRI
Chapter 4: Urinary Tract Imaging: Basic Principles of Urologic Ultrasonography
Brief History of Ultrasound in Urology
Physical Principles
Ultrasound Image Generation
Resolution
Mechanisms of Attenuation
Artifacts
Modes of Ultrasound
Gray-Scale Ultrasound
Doppler Ultrasound
Harmonic Scanning
Spatial Compounding
Sonoelastography
Three-Dimensional Scanning
Multiparametric Ultrasound
Contrast Agents in Ultrasound
Documentation and Image Storage
Report
Images
Report and Image Storage
Patient Safety
Clinical Urologic Ultrasound
Renal Ultrasound
Technique
Indications
Normal Findings
Procedural Applications
Limitations
Transabdominal Pelvic Ultrasound
Technique
Indications
Normal Findings
Procedural Applications
Limitations
Ultrasonography of the Scrotum
Technique
Indications
Normal Findings
Procedural Applications
Sonoelastography
Limitations
Ultrasonography of the Penis and Male Urethra
Technique
Indications
Normal Findings
Perineal Ultrasound
Transperineal Ultrasound
Procedural Applications
Limitations
Transrectal Ultrasonography of the Prostate
Technique
Indications
Normal Findings
Procedural Applications
Limitations
Practice Accreditation
Suggested Readings
References
Chapter 5: Urinary Tract Imaging: Basic Principles of Nuclear Medicine
Principles of Single Photon and PET Imaging
Functional Imaging of the Kidneys
Relevant Renal Physiology
Technetium-99m Diethylenetriaminepentaacetic Acid (99mTc-DTPA)
Technetium-99m Mercaptoacetyltriglycine (99mTc-MAG3)
Technetium-99m Dimercaptosuccinic Acid (99mTc-DMSA)
Dynamic Renal Imaging With 99mTc-MAG3 and 99mTc-DTPA
Patient Preparation
Dosing and Pharmacokinetics
Image Acquisition and Interpretation
Additional Applications of 99mTc-MAG3 and 99mTc-DTPA Scintigraphy
Evaluation of Renal Vascular Hypertension
Renal Transplant Evaluation
Assessment of Vesicoureteral Reflux
Renal Cortical Imaging With 99mTc-DMSA
Infection Imaging
Molecular Imaging of Genitourinary Malignancies
Bladder Cancer
Kidney Cancer
Prostate Cancer
Penile Cancer
Testis Cancer
References
Chapter 6: Assessment of Urologic and Surgical Outcomes
Establishing a Conceptual Framework for Assessing the Effectiveness of Treatment and Improving Care in Urology
Long-Term Disease Outcomes That Are Commonly Assessed in Urology
Overall Mortality
Disease-Specific Mortality
Other Binary “Survival” Outcomes
Proxy Endpoints
Disease Progression/Recurrence
Receipt of Secondary Therapy
Commonly Assessed Short-Term Outcomes
Assessing Surgical Complications
Common Terminology Criteria for Adverse Events
Clavien-Dindo System of Classifying Complications
Assessing Risk for Surgical Complications
Functional Status
Comorbidity
Frailty
Pain
Patient-Reported Outcomes
Methods of Assessing Patient-Reported Outcomes
Specific Symptom Scales
Lower Urinary Tract Symptoms
Urinary Incontinence
Sexual Dysfunction
Health-Related Quality of Life
Other Outcomes of Interest in Urology
Patient Satisfaction
Health Care Costs
References
Chapter 7: Ethics and Informed Consent
Medical Ethics
History of Medical Ethics
The Four-Principles Framework
Medical Ethics in Clinical Practice
Informed Consent
History of Informed Consent
Elements of Informed Consent
Exceptions to the Informed Consent Requirement
Quality of Informed Consent
References
Part II: Basics of Urologic Surgery
Chapter 8: Principles of Urologic Surgery: Perioperative Care
Preoperative Evaluation
Presurgical Testing
American Society of Anesthesiologists Classification and Risk
Preoperative Cardiovascular Evaluation
Clinical Markers
Functional Capacity
Surgery-Specific Cardiac Risk
Pulmonary Evaluation
Hepatobiliary Evaluation
Special Populations
Elderly
Morbid Obesity
Pregnancy
Nutritional Status
Preparation for Surgery
Management of Medications
Preoperative Optimization Strategies
Optimization of Comorbid Illness.
Antithrombotic Therapy
Bowel Preparation
Intraoperative Management
Patient Environment
Patient Safety
Patient Positioning
Antibiotic Prophylaxis
Venous Thromboembolic Prophylaxis
Anesthetic Considerations
Selection of Mode of Anesthesia
Monitored Anesthesia Care
Regional Anesthesia
General Anesthesia
Inhalational General Anesthesia.
Intravenous General Anesthesia.
Skin Preparation
Transfusion Considerations
Pain Management
Acknowledgments
Suggested Readings
References
Chapter 9: Principles of Urologic Surgery: Incisions and Access
Abdominal Incisions
Midline Incision
Pfannenstiel Incision
Gibson Incision
Anterior Approaches to the Kidney and Retroperitoneum
Thoracoabdominal Incision
Chevron and Subcostal Incisions
Flank Incisions
True Flank Incisions
12th Rib Supracostal and 11th Rib Transcostal
Inguinal Incisions
Incisions Above the Inguinal Ligament
Incisions for Inguinal and/or Pelvic Lymphadenectomy in Penile Cancer
Incisions for Specific Surgeries
Posterior Lumbodorsal Incision or Dorsal Lumbotomy
Scrotal Incisions
Penile Incisions
Perineal Incisions
Suggested Readings
References
Chapter 10: Principles of Urologic Surgery: Intraoperative Technical Decisions
Patient Environment
Patient Temperature
Skin Preparation
Patient Safety
Patient Positioning
Blood Products
Packed Red Blood Cells
Component Therapy
Massive Transfusion Protocol
Hemostatic Agents
Dry Matrix Agents
Biologically Active Agents
Drains
Penrose
Jackson-Pratt
Blake
Pigtail
Suture Material and Incision Closure
Absorbable Sutures
Plain Gut and Chromic Gut
Poliglecaprone (Monocryl), Biosyn, Caprosyn
Polyglactin 910; Vicryl
Polydioxanone and Polyglyconate (Maxon)
Nonabsorbable Sutures
Polypropylene (Prolene)
Polyester (Mersilene)
Polyamide (Nylon)
Silk
Fascial Closure Techniques
Skin Closure
Retention Sutures
Wound Dressing
References
Chapter 11: Lower Urinary Tract Catheterization
History
Anatomic Considerations
Male Urethra
Female Urethra
Indications for Lower Urinary Tract Drainage
Diagnostic
Therapeutic
Contraindications
Technique of Urethral Catheterization
Preparation for Catheterization
Urethral Catheterization in Men
Urethral Catheterization in Women
Urethral Catheterization of Children
Types of Urethral Catheters
Catheter Sizing
Double-Lumen Catheters
Single-Lumen Catheters
Hematuria Catheter
Diagnostic Catheters
Drain Catheters
Condom Catheters
Suprapubic Catheterization
Indications
Techniques
Open Cystotomy
Placement With a Guidewire and the Seldinger Technique
Difficult Catheterization
Prostatic Obstruction
Urethral Stricture
Urethral Trauma
Abnormal Anatomy
Posterior Urethral Valves
Obesity
Reconstruction of the Lower Urinary Tract
Bladder Replacement or Neobladder
Continent Urinary Reservoir or Indiana Pouch
Urinary Conduit
Bladder Neck Reconstruction or Closure
Artificial Urinary Sphincter
Complications of Lower Urinary Tract Drainage
Infection
Iatrogenic Trauma
Stricture
Erosion
Malignancy
Catheter Knotting and Balloon Malfunction
References
Chapter 12: Fundamentals of Upper Urinary Tract Drainage
Percutaneous Renal Access and Drainage
History
Indications
Simple Drainage
Diagnostic Studies
Therapeutic Instillations
Percutaneous Renal Surgery
Anatomic Considerations
Perirenal Anatomy
Renal Parenchyma and Collecting System
Intrarenal Vasculature
Surgical Technique
Provider Obtaining Access
Antimicrobial Prophylaxis
Management of Anticoagulation
Diagnostic Imaging
Patient Positioning
Prone Position
Supine Position
Modifications to Prone or Supine Positioning
Anesthetic Considerations
Choice of Calyx for Access
Upper Pole Calyx
Interpolar Calyx
Lower Pole Calyx
Image Guidance for Puncture
Fluoroscopic-Guided Access.
Ureteroscopic-Assisted Fluoroscopic Access.
Ultrasound-Guided Access.
Advanced Guidance Techniques
“Blind” Access.
Access Needles.
Guidewires.
Tract Dilation.
Postprocedural Drainage
Balloon Catheters.
Cope Catheter.
Malecot Catheter.
Nephroureteral Stent.
Circle Catheter.
General Considerations.
“Tubeless” With Ureteral Stent.
No Drainage Tube
Tract Sealants.
Training
Special Situations
Horseshoe Kidney
Pelvic/Ectopic Kidney
Transplant Kidney
Complications
Acute Hemorrhage
Delayed Hemorrhage
Collecting System Injury
Visceral Injury
Pleural Injury
Metabolic and Physiologic Complications
Postoperative Fever and Sepsis
Neuromusculoskeletal Complications
Venous Thromboembolism
Collecting System Obstruction
Loss of Renal Function
Death
Retrograde Renal Access and Drainage
History
Indications
Surgical Technique
Guidewire Placement
Stent Placement
Stent Varieties
Materials
Design
Stent Tolerance
References
Chapter 13: Principles of Urologic Endoscopy
Introduction
History of Endoscopy
Basic Equipment and Video-Endoscopic Systems
Cystourethroscopy
Indications
Equipment
Rigid Cystourethroscopes
Flexible Cystourethroscopes
Patient Preparation
Technique
Special Circumstances
Suprapubic Cystostomy
Continent Urinary Diversions
Upper-Tract Endoscopy
Indications
Urolithiasis
Upper Urinary Tract Urothelial Carcinoma
Ureteropelvic Junction Obstruction and Ureteral Stricture
Other Indications for Ureteroscopy
Equipment
Semirigid Ureteroscopes
Flexible Ureteroscopes
Digital Ureteroscopes
Care and Sterilization
Guidewires
Dilation Devices
Intraluminal Lithotripsy Devices
Stone-Retrieval Devices
Retropulsion Prevention Devices
Miscellaneous Devices
Ureteral Access Sheaths
Fluoroscopy Equipment
Ureteroscopy Technique
Preparation for Ureteroscopy
Accessing the Ureter
Semirigid Ureteroscopy Technique
Flexible Ureteroscopy Technique
Conclusion
Suggested Readings
References
Chapter 14: Fundamentals of Laparoscopic and Robotic Urologic Surgery
Preoperative Preparation
Patient Selection and Contraindications
Morbid Obesity
Extensive Prior Abdominal or Pelvic Surgery
Pelvic Fibrosis
Organomegaly
Ascites: Benign Cause
Pregnancy
Hernia
Iliac or Aortic Aneurysm
Bowel Preparation
Enhanced Recovery After Surgery Protocols
Preparation of Blood Products
Operating Room
Setup of the Operating Room
Patient Positioning
Prophylaxis and Other Preparations
Strategic Placement of Operative Team and Equipment
Standard Laparoscopic Carts
Integrated Endoscopy Systems
Robotic Systems
Placement of the Operative Team for Laparoscopic Procedures
Transperitoneal Procedures in the Upper Abdomen
Laparoscopic.
Robotic.
Retroperitoneal Procedures in the Upper Abdomen
Laparoscopic.
Robotic.
Transperitoneal and Extraperitoneal Pelvic Procedures
Laparoscopic.
Robotic.
Performing the Procedure
Before the Initial Incision
Achieving Transperitoneal Access and Establishing the Pneumoperitoneum
Closed Techniques
Veress Needle.
Sites for Needle Passage.
Assessment of Proper Needle Placement.
Open Access Techniques
Hasson Technique.
Hand Port Access.
Laparoendoscopic Single-Site Surgery
Robotic Laparoendoscopic Single-Site Surgery
Retroperitoneal Access and the Retroperitoneal Space
Technique for Balloon or Self-Styled Dilator Placement: Open (Hasson) Technique
Balloon Dilation.
Commercially Available Balloons.
Self-Styled Dilators.
Manual Dilation.
Extraperitoneal Access and the Extraperitoneal Space
Technique for Balloon or Self-Styled Dilator Placement: Open (Hasson) Technique
Limitations and Advantages of Transperitoneal Versus Extraperitoneal Approach to the Flank and Pelvis
Transperitoneal Versus Retroperitoneal Renal and Adrenal Surgery.
Transperitoneal Versus Extraperitoneal Pelvic Surgery.
Access Technology: Trocars, Hand Ports, and Single-Port Access
Trocars
Hand-Assist Devices
Laparoendoscopic Single-Site Surgery Access Devices
Robotic Laparoendoscopic Single-Site Surgery Devices.
Trocar Placement
Placement of Initial Trocar
Hand-Assist Placement
Secondary Trocar Placement
Standard Approach.
Hand-Assist Approach.
Trocar Configuration
Robotic Considerations
Laparoscopic Instrumentation
Instruments for Visualization
Laparoscope and Camera
Standard Systems.
Three-Dimensional Systems.
Instrumentation for Grasping and Blunt Dissection
Instrumentation for Incising and Hemostasis
Sharp Dissectors.
Monopolar Electrosurgical Devices.
Bipolar Electrosurgical Devices.
Laser Instrumentation.
Ultrasound Instrumentation.
Combined Devices and Other Instrumentation.
Surgical Pharmaceuticals
Fibrin-Based Glue.
Non–Fibrin-Based Surgical Hemostats.
Chemical-Based Sealants.
Instrumentation for Suturing and Tissue Anastomosis
Needle Drivers.
Endo Stitch.
Lapra-Ty Clips.
Barbed Suture.
Instrumentation for Stapling and Clipping
Stapling Devices.
Clipping Devices.
Instrumentation for Specimen Entrapment
Instrumentation for Morcellation
Instrumentation for Retraction
Mechanical Assistants.
Robotic Instrumentation
Instrumentation for Incising and Hemostasis
Instrumentation for Grasping and Blunt Dissection
Instrumentation for Suturing and Tissue Anastomosis
Other Available 8-mm and 5-mm Instruments
Instrumentation for Single-Site Surgery
Instrumentation for Natural Orifice Transluminal Endoscopic Surgery
Exiting the Abdomen
Port Removal and Fascial Closure
Instrumentation for Port Site Closure
Closure of the Skin
Physiologic Considerations in the Adult
Choice of Insufflant
Carbon Dioxide
Alternative Gases
Choice of Pneumoperitoneum Pressure
Cardiovascular Effects of the Pneumoperitoneum
Venous Flow
Cardiac Arrhythmias
Unreliability of Central Venous Pressure Readings
Respiratory Effects of the Pneumoperitoneum
Pressure-Mediated Effects
Non–Pressure-Related Respiratory Effects
Renal Effects of the Pneumoperitoneum
Effects of the Pneumoperitoneum on Mesenteric Blood Flow and Intestinal Motility
Acid-Base Metabolic Effects of Pneumoperitoneum
Hemodynamic Effects Related to Patient Position and Type of Approach
Hormonal and Metabolic Effects During Laparoscopic Surgery
Immunologic Effects of Laparoscopic Surgery
Complications and Troubleshooting in Laparoscopic and Robotic Surgery
Minimizing the Incidence of Complications During the Learning Curve
General Procedural Complications
Malfunction of Equipment
Complications Related to Obtaining the Pneumoperitoneum
Complications Associated With Closed Access (Veress Needle Placement)
Preperitoneal Placement.
Vascular Injuries.
Visceral Injuries.
Complications During Open Access (Hasson Technique).
Complications Related to Insufflation and Pneumoperitoneum
Bowel Insufflation.
Gas Embolism.
Barotrauma.
Subcutaneous Emphysema.
Pneumomediastinum, Pneumothorax, and Pneumopericardium.
Complications Related to Initial “Blind” Placement of the First Trocar After Obtaining a Veress Needle Pneumoperitoneum
Injury to Gastrointestinal Organs.
Injury to Intra-abdominal Vessels.
Injury to the Urinary Tract.
Complications Related to Placement of Secondary Trocars
Bleeding at the Sheath Site.
Trocar Position–Related Problems.
Complications Related to General Anesthesia Unique to Laparoscopy
Cardiac Arrhythmias and Cardiac Arrest.
Changes in Blood Pressure.
Aspiration of Gastric Contents.
Hypothermia.
Complications Related to the Surgical Procedure
Bowel Injury: Electrosurgical.
Bowel Injury: Mechanical.
Vascular Injury.
Nerve Injury.
Injury to the Urinary Tract, Spleen, or Pancreas.
Injury to the Urinary Tract
Bladder Injury.
Ureteral Injury.
Pancreatic Injury.
Splenic Injury.
Complications Related to Exiting the Abdomen
Bowel Entrapment.
Bleeding at the Sheath Site.
Early Postoperative Complications
Pain.
Incisional Hernia.
Deep Venous Thrombosis and Pulmonary Embolism.
Wound Infections.
Rhabdomyolysis.
Late Postoperative Complications
Lymphocele Formation.
Chylous Ascites.
Training and Practicing Laparoscopic and Robotic Surgery
Equipment for Practicing Laparoscopic and Robotic Surgery
Laparoscopic Training Boxes
Live Animal Models.
Cadaveric Models.
Virtual Reality Trainers
Formal Training Programs
Conclusion
Acknowledgment
Suggested Readings
References
Chapter 15: Basic Energy Modalities in Urologic Surgery
Tissue Dissection and Cauterization
Electrosurgery
Monopolar Electrosurgery
Basic Physics.
Argon Beam Coagulator.
Generator Settings.
Safety
Capacitive Coupling.
General Safety Tips.
Types of Electrosurgical Instruments
Monopolar Devices.
Bipolar Devices.
Ultrasonic Instrumentation (High-Frequency Vibratory Device)
Comparing Various Energy-Sealing Devices
Laser Instrumentation: Soft-Tissue Applications
Pulsed and Continuous Wave Lasers
Delivery Systems
Light-Tissue Interaction
Types of Lasers
Neodymium:Yttrium-Aluminum-Garnet.
Potassium Titanyl Phosphate.
Lithium Triborate.
Diode.
Holmium:YAG.
Thulium:YAG.
Carbon Dioxide.
Intracorporeal Lithotripters
Electrohydraulic Lithotripsy
Physics and Mechanism of Action
Tissue Effect
Ureteroscopy
Bladder Stones
Pneumatic Lithotripsy
Basic Physics
Tissue Effects
Ureteroscopy
Bladder Stones
Percutaneous Nephrolithotomy
Ultrasonic Lithotripsy
Basic Physics
Tissue Effects
Ureteroscopy
Percutaneous Surgery
Holmium:YAG and Erbium:YAG Laser Lithotripsy
Basic Physics
Ureteroscopy
Percutaneous Nephrolithotomy
Bladder Stones
Dual-Modality Lithotripters
LithoClast Ultra
CyberWand
ShockPulse-SE
Tissue Effects
Clinical Use
Suggested Readings
References
Chapter 16: Evaluation and Management of Hematuria
Classification and Timing of Hematuria
Microscopic Hematuria
Criteria for the Diagnosis of Microhematuria
Requirement for Microscopic Evaluation
Causes of Microhematuria
Selecting Patients for Evaluation of Microhematuria
The Question of Screening for Hematuria and Bladder Cancer
Guideline-Based Evaluation of Patients With Microhematuria
Cystoscopy in the Diagnostic Evaluation of Hematuria
Upper Tract Imaging in the Diagnostic Evaluation of Hematuria
Urine Cytology and Urinary Biomarkers in the Diagnostic Evaluation of Hematuria
Natural History of Microhematuria in Patients With a Negative Initial Evaluation
Symptomatic Microscopic Hematuria
Gross Hematuria
Hemorrhagic Cystitis
Management of Hemorrhagic Cystitis
Hematuria From Prostatic Origin
Urethral Bleeding
Hematuria Originating From the Upper Urinary Tract
Medical Renal Disease
Vascular Conditions Affecting the Urinary Tract
Lateralizing Essential Hematuria and the Evaluation of Upper Urinary Tract Bleeding
Suggested Readings
References
Chapter 17: Complications of Urologic Surgery
Classification of Complications
The Clavien-Dindo Scale
Physiologic Complications
Positional and Neuromuscular Complications
Positional Nerve Injury
Operative Nerve Injury
Gluteal Compartment Syndrome
Lower Extremity Compartment Syndrome
Urinary Complications
Urine Leaks After Upper Tract Urologic Surgery
Urine Leaks After Partial Nephrectomy
Risk Factors and Diagnosis
Management
Ureteral Injuries
Incidence and Anatomic Landmarks
Mechanisms of Ureteral Injury
Intraoperative Management
Presentation of Unrecognized Ureteral Injuries
Ureterovaginal Fistula
Strictures
Lower Tract Urinary Complications
Bladder Injuries
Urine Leaks After Radical Prostatectomy
Overview
Contributing Factors
Diagnosis
Management
Vascular Complications
Overview
Intraoperative Vascular Complications
Management
Vascular Injury During Abdominal Access
Mechanisms of Injury
Comparison of Different Access Techniques
Management of Vascular Incidents
Injury to Epigastric Vessels
Injury to Major Vessels
Stapler Malfunction
Postoperative Vascular Complications
Diagnosis and Management
Bowel Injuries
Incidence and Presentation
Mechanisms of Injury
Duodenal and Pancreatic Injuries During Nephrectomy
Rectal Injury
Management
Port Site Hernia
Venous Thromboembolism
Lymphoceles
Conclusion
References
Chapter 18: Urologic Considerations in Pregnancy
Physiologic Changes During Pregnancy
Cardiovascular
Respiratory
Hematologic
Renal and Urinary Tracts
Urine Chemistries During Pregnancy
Hematuria in the Pregnant Patient
Physiologic Hydronephrosis of Pregnancy
General Considerations for Imaging of the Pregnant Patient
General Concepts for Surgical Management of the Pregnant Patient
General Concepts of Urologic Medication Administration During Pregnancy
Urolithiasis in Pregnancy
Etiology
Evaluation
Pregnancy in Women With Congenital Urologic Conditions
Myelomeningocele
Fertility
Pregnancy
Mode of Delivery
Prevention of Neural Tube Defects
Classic Bladder Exstrophy
Genital Anatomy
Fertility
Pregnancy
Mode of Delivery
Functional and Anatomic Urologic Concerns During Pregnancy
Intermittent Catheterization
Urinary Diversion
Continent Catheterizable Stoma
Urinary Tract Infection and Urinary Diversion
Urologic Malignancy During Pregnancy
Renal Tumors
Angiomyolipoma
Bladder Tumors
Management of Urinary Tract Infections in Pregnancy
Urologic Management of Placental Abnormalities
Acknowledgments
References
Chapter 19: Intraoperative Consultation
Ethical Considerations
The Patient-Physician (and Family-Physician) Relationship
Decision Making
Documentation
Surgical Time Out
Urethral Injury
Incidence
Mechanisms
Diagnosis
Management
Bladder Injury
Incidence
Mechanisms
Diagnosis/Recognition
Management
Ureteral Injury
Incidence
Mechanisms
Diagnosis/Recognition
Management
Principles of Repair
Grade 1 and 2 Injuries
Grade 3 to 5 Distal Ureteral Injuries
Grade 3 to 5 Mid- and Proximal Ureteral Injuries
Grade 5 Injury
Ureteroscopic Avulsion Injury
Ureteral Catheters
Renal Injury
Incidence
Mechanisms
Diagnosis/Recognition
Management
Placental Cases
Consults From Urology Colleagues
References
Ethical Considerations
Decision Making
Documentation
Urethral Injury
Bladder Injury
Ureteral Injury
Renal Injury
Placental Cases
Part III: Pediatric Urology
Section A: Development and Prenatal Urology
Chapter 20: Embryology of the Genitourinary Tract
Development of the External Genitalia
Clinical Correlation: Hypospadias
Clinical Correlation: Correction of Penile Curvature
Clinical Correlation: Duplicated Urethra
Development of the Female External Genitalia
Clinical Correlation: Congenital Adrenal Hyperplasia
Development of the Human Prostate
Development of the Human Seminal Vesicle
Development of the Gonads
Testicular Formation
Ovarian Formation
Gonadal Descent
Clinical Correlation: Cryptorchidism
Clinical Correlation: Streak Gonad
Clinical Correlation: Ovotesticular Syndrome
Clinical Correlation: Persistent Müllerian Duct Syndrome
Müllerian Structures (Female Internal Genitalia)
Development of the Human Female Reproductive Tract
Uterine Tube
Uterus Corpus and Cervix
Vagina
Clinical Correlation: Vaginal Agenesis and Imperforate Hymen
Clinical Correlation: Uterus Didelphys
Clinical Correlation: Obstructed Hemivagina and Unilateral Renal Anomalies
Bladder: Ureteral Development
Formation of Urogenital Sinus
Formation of Trigone
Development of the Ureter
Development of the Bladder and Continence Mechanism
Clinical Correlation: Vesico-ureteral Reflux
Clinical Correlation: Bladder Exstrophy
Clinical Correlation: Urachal Anomalies
Clinical Correlation: Duplication Anomalies
Clinical Correlation: Ectopic Ureter
Clinical Correlation: Ureterocele
Kidneys
Early Events in Kidney Development
Pronephros and Mesonephros
Metanephros
Collecting System
Molecular Mechanisms of Kidney Development
Formation of Nephric Ducts
Ureteric Bud Outgrowth Into Metanephric Mesenchyme
Ureteric Bud Branching
Tubulogenesis
Mesenchymal-Epithelial Conversion
Renal Vascular Development
Clinical Correlation: Vascular Anomalies
Clinical Correlation: Ascent Anomalies
Clinical Correlation: Cystic Renal Disease
Clinical Correlation: Multicystic Dysplastic Kidneys
Acknowledgment
Suggested Readings
References
Chapter 21: Urologic Aspects of Pediatric Nephrology
Introduction
Renal Function, Fluid, and Electrolyte Homeostasis
Renal Development
Glomerular Filtration Rate
Tubular Function
Developmental Changes in Glomerular Filtration Rate and Tubular Function
Hematuria (Microscopic and Gross)
Proteinuria
Glomerular Disease
Nephrotic Syndrome
Glomerulonephritis
Normocomplementemic Glomerulonephritis
Tubulopathies
Cystic Renal Disease
Urolithiasis: Medical Management
Hypertension
Acute Kidney Injury
Chronic Kidney Disease
End-Stage Renal Disease: Dialysis and Renal Transplantation
Summary
Suggested Readings
References
Chapter 22: Perinatal Urology
Prenatal Imaging
Maternal-Fetal Ultrasound
Fetal Magnetic Resonance Imaging
Grading Systems
Anterior-Posterior Renal Pelvic Diameter
Society for Fetal Urology Grading System
Urinary Tract Dilation Grading System
Prenatal Multidisciplinary Consultations
Parental Counseling for Fetal Intervention
Parental Counseling for Prenatal Surgery for Myelomingocele Closure
Urinary Tract Dilation
Risk Stratification and Management for Prenatal Urinary Tract Dilation
Prenatal Management
Prenatal Intervention for Lower Urinary Tract Obstruction
Fetal Cystoscopy
Vesicoamniotic Shunt Placement Versus Fetal Cystoscopy
Postnatal Evaluation and Management
Imaging
Renal Ultrasound/Resolution of Urinary Tract Dilation
Voiding Cystourethrogram
Renal Scintigraphy
Magnetic Resonance Urography
Management Recommendations for Postnatal Urinary Tract Dilation
P1 Urinary Tract Dilation (Low Risk)
P2 Urinary Tract Dilation (Intermediate Risk)
P3 Urinary Tract Dilation (High Risk)
Considerations for Severe Bilateral Urinary Tract Dilation
Urinary Tract Infection
Prophylactic Antibiotics
Key Conditions
Etiology of Prenatal Urinary Tract Dilation
Transient Urinary Tract Dilation
Ureteropelvic Junction Obstruction Pattern of Dilation
Recommendations for Ureteropelvic Junction Obstruction Pattern of Dilation
Vesicoureteral Reflux
Recommendations for Vesicoureteral Reflux
Megaureter/Ureterovesical Junction Obstruction
Recommendations for Megaureter
Lower Urinary Tract Obstruction (Posterior Urethral Valve, Prune Belly Syndrome, Urethral Stenosis/Atresia)
Posterior Urethral Valves
Prune Belly Syndrome/Megalourethra
Urethral Stenosis/Atresia
Congenital Megacystis
Recommendations for Lower Urinary Tract Obstruction
Kidney Anomalies
Multicystic Dysplastic Kidney
Recommendations for Multicystic Dysplastic Kidney
Duplication Anomalies/Ureterocele/Ectopic Ureter
Recommendations for Duplex Anomalies
Exstrophy (Bladder/Cloacal)
Bladder Exstrophy
Recommendations for Bladder Exstrophy
Cloacal Exstrophy
Recommendations for Cloacal Bladder Exstrophy
Cloacal Malformation/Urogenital Sinus/ Congenital Adrenal Hyperplasia
Cloacal Malformation
Urogenital Sinus/Congenital Adrenal Hyperplasia
Prenatal Treatment of Congenital Adrenal Hyperplasia
Postnatal Treatment of Congenital Adrenal Hyperplasia
Outcomes for Fetal Myelomeningocele Closure
Perinatal Urgencies/Emergencies
Neonatal Urologic Emergencies
Abdominal Distension
Upper Urinary Tract Obstruction
Lower Urinary Tract Obstruction
Urinary Ascites
Urinary Retention (>24 Hours After Birth)
Solid or Cystic Renal Masses
Anorectal Malformation
Ambiguous Genitalia
Intralabial Masses in a Female Patient
Oliguria/Anuria
Gross Hematuria
Scrotal Mass in the Neonate
Testicular Torsion
References
Section B: Basic Principles
Chapter 23: Urologic Evaluation of the Child
Overview of Pediatric Urology
Imaging
Ultrasonography
Renal Bladder Ultrasound
Prenatal Ultrasonography
Scrotal Ultrasonography
Occult Spinal Dysraphism
Voiding Cystourethrogram
Fluoroscopy
Nuclear Cystography
Genitography
Renal Scintigraphy
Diuretic Renography
Renal Cortical Scintigraphy
Urodynamic Testing
Advanced Imaging
Magnetic Resonance Imaging
Computed Tomography
Presentations by Genitourinary Region
External Genitalia of the Male
Scrotal Conditions
Undescended Testicle.
Scrotal and Testicular Pain.
Testicular Torsion.
Torsion of the Testicular or Epididymal Appendix.
Epididymo-orchitis.
Scrotal Mass
Hernia and Hydrocele.
Varicocele.
Testicular Tumor.
Penile Conditions
Foreskin
Phimosis and Paraphimosis.
Circumcision.
Smegma Pearl or Smegmoma.
Inconspicuous Penis.
Buried Penis.
Concealed Penis.
Webbed Penis.
Abnormal Penile Orientation
Penile Torsion.
Penile Curvature.
Parameatal Urethral Cyst.
Hypospadias.
Priapism.
External Genitalia of the Female
Labial Adhesions
Interlabial Masses
Hymenal Disorders
Imperforate Hymen.
Hymenal Skin Tag.
Paraurethral Cyst.
Urethral Prolapse
Prolapsing Ureterocele
Vaginal Rhabdomyosarcoma
Vaginal Discharge
Bladder and Bowel Dysfunction
Foreign Body
Sexual Abuse
Other Vaginal Disorders
Urinary Tract
Urinary Tract Infection and Pyelonephritis
Vesicoureteral Reflux
Bladder and Bowel Dysfunction
Urinary Incontinence
Sexual Abuse
Flank Pain
Nephrolithiasis.
Pyelonephritis.
Ureteropelvic Junction Obstruction
Gross Hematuria
Microhematuria
Benign Idiopathic Urethrorrhagia.
Referral for Ultrasound Findings
Prenatal Hydronephrosis.
Renal Cysts
Renal Tumors
Incidental Urolithiasis
Acknowledgments
References
Chapter 24: Pediatric Urogenital Imaging
Technique
Nonionizing
Ionizing
sonography
Fundamentals of Sonography in the Fetus and Child
Kidney/Ureter
Obstruction
Hydronephrosis Versus Cystic Renal Diseases.
Dilated Ureters.
Functional Interpretation of Sonography of the Kidney.
Cysts/Masses/Stones
Renal Cysts.
Renal/Abdominal Solid Masses.
Renal Stones.
Ureteral Stones.
Infection
Other Congenital Malformations
Trauma
Bladder/Urethra
Obstruction
Cysts/Masses
Midline Pelvic Cysts.
Bladder Tumors.
Infection
Other Congenital Malformations
Abdominal Wall Defects.
Trauma
Scrotum/Testes/Internal Genitalia
Acute Scrotum.
Cysts/Masses
Undescended Testis
Differences of Sex Development
Magnetic Resonance Imaging
Fundamentals of MRI in the Fetus and Child
Protocol
Sedation in the Child
Kidney/Ureter
Hydronephrosis/Obstruction
Cysts/Masses/Stones
Infection
Other Congenital Malformations
Bladder/Urethra
Scrotum/Testes/Internal Genitalia
Acute Scrotum
Cysts/Masses
Undescended Testis
Differences of Sex Development
Conventional Radiography
Plain Abdominal Radiography
Intravenous Pyelography
Retrograde Pyelography
Voiding Cystourethrography/Micturating Cystourethrogram
Fundamentals of Voiding Cystourethrography
Kidney/Ureter
Obstruction
Cysts/Masses
Infection
Other Congenital Malformations
Trauma
Bladder/Urethra
Obstruction
Cysts/Masses
Infection
Other Congenital Malformations
Trauma
Scrotum/Testes/Internal Genitalia
Differences of Sex Development
Computed Tomography
Fundamentals of CT Imaging in Children
Kidney/Ureter
Obstruction
Cysts/Masses
Infection
Calculus Disease
Trauma
Bladder/Urethra
Trauma
Scrotum/Testes/Internal Genitalia
DMSA Renal Cortical Scintigraphy
Diuretic Renal Scintigraphy
Radionuclide Cystography
Radionuclide Testicular Scanning
Suggested Readings
References
Chapter 25: Infection and Inflammation of the Pediatric Genitourinary Tract
Evaluation and Management of a Child With a Fever
Definition of a Urinary Tract Infection
Pathogenesis of Urinary Tract Infection Development in Children
Bacterial Factors Leading to Pediatric Urinary Tract Infections
Bacterial Fimbriae
Aerobactin
Hemolysin
Capsular Polysaccharide
Biofilm Formation
Host Risk Factors Leading to Pediatric Urinary Tract Infections
Gender and Age
Race
Genetics
Circumcision
Fecal and Perineal Bacterial Colonization
Anatomic Abnormalities
Vesicoureteral Reflux
Sexual Activity
Bladder and Bowel Dysfunction
Neurogenic Bladder
Iatrogenic Factors
Immune Status
Classification of Pediatric Urinary Tract Infections
Biofilms
Asymptomatic Bacteriuria
Bacterial Nephritis
Pyonephrosis
Acute Renal Abscess
Diagnosis of Pediatric Urinary Tract Infection
Symptoms
Physical Examination
Laboratories
Urine Collection Methods
Urinalysis
Urine Dipstick Tests
Urine Microscopic Examination
Urine Culture
Serum Tests
Radiographic Imaging
Controversies With Imaging Strategies
Ultrasound
Voiding Cystourethrogram
99mTc-Dimercaptosuccinic Acid
Computed Tomography
Magnetic Resonance Imaging
Management of Pediatric Urinary Tract Infection
Antibiotic Treatment
Inpatient Versus Outpatient Management
Antibiotic Duration
Antibiotic Selection
Management After Urinary Tract Infection
Prophylactic Antibiotics
Bladder and Bowel Dysfunction
Management of Vesicoureteral Reflux
Sequelae of Pediatric Urinary Tract Infections
Renal Scarring
Xanthogranulomatous Pyelonephritis
Long-Term Sequelae
Uncommon Pediatric Urinary Tract Infections
Viral Cystitis
Funguria
Suggested Readings
References
Chapter 26: Core Principles of Perioperative Management in Children
Pediatric Anesthesia
Perioperative Home
Anesthesia and Potential Neurocognitive Effects
Preoperative Assessment and Preparation for Surgery
Anesthesia Risk
Preoperative Setting
Special Preoperative Considerations
Jehovah’s Witness
Department of Social Services
Pain Assessment Tools
NPO Status
Fasting Times
Special NPO Situations
Ketogenic Diet
Enteral Tube Feeds
Diabetes and Metabolic Disorders
Medication Administration
Preoperative Studies
Laboratory Tests
Chest X-Ray and Electrocardiogram
Pulmonary Function Testing
Urine Evaluation
Comorbidities: Perioperative Planning and Postoperative Considerations
Premature Infants
Asthma and Pulmonary Disease
Acute Upper Respiratory Tract Infection (URTI)
Cardiovascular Anomalies
Renal Abnormalities
Hematologic Disorders
Oncologic Disorders
Chemotherapy and Perioperative Considerations
Pheochromocytoma
Spina Bifida
Congenital Adrenal Hyperplasia
Acute Preoperative Events
Sepsis
Trauma
Upper Respiratory Tract Infection
Urinary Tract Infection (UTI)
Nonspecific Fever
ERAS Protocols
Intraoperative Considerations
Preoperative Antibiotics
Intraoperative and Perioperative Fluid Management
Anaphylaxis
Malignant Hyperthermia
Laparoscopic Procedures
Intraoperative Pain Management
Postoperative Management
Immediate Postoperative Management
Postanesthesia Care Unit and Pain Management
Inpatient and Outpatient Postoperative Pain Management
Opioid Use in Children
References
Chapter 27: Principles of Laparoscopic and Robotic Surgery in Children
Advantages and Disadvantages of Minimally Invasive Surgery
Advantages of Minimally Invasive Surgery
Drawbacks of Minimally Invasive Surgery
Physiology of the Pneumoperitoneum
Cardiovascular Changes
Pulmonary Changes
Intracranial Pressure
Renal Physiology
Stress Response to the Pneumoperitoneum
Patient Selection for Mimimally Invasive Surgery
Access
Veress Needle
Open Access
Visual Obturator Access
Comparative Effectiveness of Access Techniques
Approach
Transperitoneal
Retroperitoneal
Vesicoscopic
Equipment and Instrumentation
Laparoscopic Ports
Single-Site Surgery
Hemostatic Devices
Staplers
Clips
Suture Assistance
Robotic-Assisted Surgery
Complications of Minimally Invasive Surgery
Visceral Injury
Vascular Injury
Incisional Hernia (Fig. 27.8)
Pulmonary Air Embolus
Simulation Training and Evaluation
Minimally Invasive Surgery Training
Minimally Invasive Surgery Assessment
Minimally Invasive Surgery Simulation
Minimally Invasive Surgery Warm-Up
Minimally Invasive Surgery Learning Curves
Conclusion
Suggested Readings
References
Section C: Lower Urinary Tract Conditions
Chapter 28: Clinical and Urodynamic Evaluation of Lower Urinary Tract Dysfunction in Children
Clinical Evaluation
History
Storage Symptoms
Voiding Symptoms
Bowel Function
Clinical Aids
Urinary Tract Infections
Neurologic Function
Validated Questionnaires
Dysfunctional Voiding Symptom Score.
Dysfunctional Voiding and Incontinence Scoring System.
Pediatric Urinary Incontinence Quality of Life Score.
Incontinence Symptom Index-Pediatric.
Psychological Screening.
Child Behavior Checklist.
Short Screening Instrument for Psychological Problems in Enuresis.
Selecting an Appropriate Patient-Reported Outcome Measure.
Physical Examination
Vital Signs
Neurologic Examination
Abdominal Examination
Genital Examination
Laboratory Testing
Urinalysis
Urine Culture
Additional Testing
Urodynamic Evaluation
Noninvasive Testing
Uroflowmetry
Bell-Shaped Curve.
Tower-Shaped Curve.
Staccato-Shaped Curve.
Interrupted-Shaped Curve.
Plateau-Shaped Curve.
Further Standardization.
Pelvic Ultrasonography
Bladder Wall Thickness.
Postvoid Residual.
Rectal Diameter.
Urinary Debris.
Future.
Patch Electromyography
Other Measures
Formal Urodynamics
Unique Considerations in Pediatric Patients
Interpretation of Studies
Frequency of Testing
Evaluation Strategies for Specific Clinical Entities
Non-Neurogenic Lower Urinary Tract Dysfunction
Spinal Dysraphism
Sacral Agenesis
Anorectal Malformations
Posterior Urethral Valves
Pelvic Tumors Requiring Extirpation
Cerebral Palsy
Spinal Cord Injury
Transverse Myelitis and Other Central Nervous System Disorders
Acknowledgments
Suggested Readings
References
Chapter 29: Management Strategies for Vesicoureteral Reflux
Historical Perspective
Demographics
Prevalence
Sex
Reflux in the Fetus
Age
Race
Inheritance and Genetics
Sibling Reflux
Genes Involved
Embryology of the Ureterovesical Junction
Functional Anatomy of the Antireflux Mechanism
Causes of Vesicoureteral Reflux
Primary Reflux
Secondary Reflux
Clinical Correlates
Urinary Tract Infection and Reflux
Grading of Reflux
Cortical Defects
Congenital Defects Versus Acquired Scar
Reflux-Associated Renal Dysplasia
Acquired Renal Scars
Pathophysiology of Acquired Scarring
Age
Papillary Anatomy
Bacterial Virulence
Host Susceptibility and Response
Hypertension
Renal Growth
Renal Failure and Somatic Growth
Diagnosis and Evaluation of Vesicoureteral Reflux
Confirmation of Urinary Tract Infection
Evaluating Urinary Tract Infection
Assessment of the Lower Urinary Tract
Cystographic Imaging
Cystoscopy and the Positioning of the Instillation of Contrast Cystogram
Assessment of the Upper Urinary Tract
Rationale for Serial Assessment of Upper Tracts
Renal Sonography
Renal Scintigraphy
Controversies in Usage of Invasive Investigations
Renal Scintigraphy and the Top-Down Approach
Controversies in Usage of Invasive Investigations
National Institutes for Clinical Excellence Guidelines
American Academy of Pediatrics Guidelines for Febrile Urinary Tract Infection Diagnosis and Management in Young Children
Associated Anomalies and Conditions
Ureteropelvic Junction Obstruction
Ureteral Duplication
Bladder Diverticula
Renal Anomalies
Megacystis-Megaureter Association
Other Anomalies
Pregnancy and Reflux
Natural History and Management
Spontaneous Resolution
Resolution by Grade
Resolution by Age
Principles of Management
Medical Management: Continuous Antibiotic Prophylaxis
Antibiotic Controversies and Potential New Approaches
Landmark Studies
International Reflux Study in Children
Birmingham Reflux Study (Birmingham Reflux Study Group 1987)
Swedish Reflux Study
Randomized Intervention for the Management of Vesicoureteral Reflux Study
Additional Prospective Studies
Individualizing Patient Care
References
Chapter 30: Bladder Anomalies in Children
Congenital Bladder Anomalies
Embryology of the Urinary Bladder
Normal and Abnormal Antenatal Sonographic Findings of the Bladder
Nondilated or Absent Bladder
Bladder Agenesis.
Bladder Hypoplasia.
Cloacal and Bladder Exstrophy.
Dilated Bladder and Congenital Megacystis
Megacystis.
Megacystis Microcolon Intestinal Hypoperistalsis Syndrome.
Bladder Duplication
Congenital Diverticula
Paraureteral Congenital Diverticula.
Posterolateral and Multiple Congenital Diverticula.
Urachal Anomalies
Patent Urachus.
Urachal Sinus.
Urachal Cyst.
Urachal Diverticulum.
Acquired Bladder Anomalies in Children
Noninflammatory Acquired Conditions
Acquired Diverticula
Bladder Hemangiomas
Fibroepithelial Polyps
Inflammatory Acquired Conditions
Nephrogenic Adenoma and Cystitis Cystica
Eosinophilic Cystitis
Hemorrhagic Cystitis
Acknowledgments
References
Chapter 31: Exstrophy-Epispadias Complex
Historical Aspects
Incidence and Inheritance
Embryology
Classic Bladder Exstrophy
Anatomic Considerations
Bony Pelvis and Spinal Defects
Pelvic Floor Defects
Abdominal Wall Anomalies
Anorectal Defects
Male Genital Defect
Female Genital Defects
Urinary Defects
Exstrophy Complex and Variants
Prenatal Diagnosis
Surgical Reconstruction of Bladder Exstrophy
Evaluation and Management at Birth
Selection of Patients for Immediate Closure
Small Exstrophy Bladder Unsuitable for Newborn Closure
Osteotomy
Complications of Osteotomy and Immobilization Techniques
Surgical Options in the Newborn With Classic Bladder Exstrophy
Kelly Repair
Complete Repair: Complete Primary Repair of Exstrophy
Schrott-Erlangen Approach
Mainz Repair
Modern Staged Reconstruction of Bladder Exstrophy
Bladder, Posterior Urethral, and Abdominal Wall Closure
Combined Bladder Closure and Epispadias Repair
Management After Primary Closure
Selected Technical Aspects of Other Methods of Closure
Kelly Repair
Mitchell Repair
Penile and Urethral Closure in Exstrophy
Epispadias Repair
Chordee
Urethral Reconstruction
Penile Skin Closure
Postoperative Problems
Female Exstrophy
Continence and Antireflux Procedure
Postoperative Care
Modern Initial Repair of Bladder Exstrophy: Outcomes and Results
Initial Closure
Epispadias Repair
Bladder Neck Repair
Other Modern Exstrophy Repairs: Continence Outcomes
Schrott-Erlangen Approach
Complete Repair
Kelly Repair
Exstrophy Reconstruction Failures and Complications
Failed Closure
Failed Bladder Neck Repair
Failed Genitourethral Reconstruction
Alternative Techniques of Reconstruction
Ureterosigmoidostomy
Continent Urinary Diversion in the Exstrophy Patient
Transitional Exstrophy Patient: Adolescent and Adult Concerns
Continence
Male Concerns
Sexuality
Male Fertility
Female Concerns
Sexuality
Female Fertility
Quality of Life
Long-Term Adjustment Issues
Epispadias
Male Epispadias
Associated Anomalies
Surgical Management
Female Epispadias
Associated Anomalies
Surgical Objectives
Operative Techniques
Surgical Results
Cloacal Exstrophy
Anatomic Considerations
Neurospinal Abnormalities
Skeletal System Abnormalities
Intestinal Tract Abnormalities
Genitourinary Abnormalities
Additional System Anomalies
Cloacal Exstrophy Variants
Prenatal Diagnosis
Surgical Reconstruction of Cloacal Exstrophy
Evaluation and Management at Birth
Gender Assignment
Immediate Surgical Reconstruction
Urinary Reconstruction
Modern Staged Reconstruction
Role of Osteotomy
Single-Stage Reconstruction
Failed Cloacal Exstrophy
Techniques to Create Urinary Continence
Long-Term Issues in Cloacal Exstrophy
Summary
Dedication
Acknowledgment
Suggested Readings
References
Chapter 32: Prune-Belly Syndrome
Genetics
Embryology
Clinical Features of Prune-Belly Syndrome
Genitourinary Anomalies
Kidneys
Ureters
Bladder
Prostate and Accessory Sex Organs
Anterior Urethra
Testes
Extragenitourinary Abnormalities
Abdominal Wall Defect
Cardiac Anomalies
Pulmonary Abnormalities
Gastrointestinal Abnormalities
Orthopedic Abnormalities
Oral Abnormalities
Presentation
Prenatal Diagnosis and Management
Neonatal Presentation
Spectrum of Disease
Category I
Category II
Category III
Incomplete Syndrome
Adult Presentation
Female Syndrome
Evaluation and Management
Initial Management
Surgical Management of the Patient With Prune-Belly Syndrome
Urinary Tract
Urinary Diversion
Supravesical Urinary Diversion.
Cutaneous Vesicostomy.
Upper Urinary Tract Reconstruction
Ureteroplasty and Ureterocystoneostomy.
Pyeloplasty.
Lower Urinary Tract Reconstruction
Reduction Cystoplasty.
Internal Urethrotomy.
Anterior Urethral Dilation or Reconstruction.
Circumcision.
Testes: Orchidopexy
Transabdominal Orchidopexy.
Spermatic Vessel Ligation.
Laparoscopic Orchidopexy.
Abdomen: Reconstruction of the Abdominal Wall
Indications.
Techniques
Randolph Technique.
Ehrlich Technique.
Monfort Technique.
Dénes Technique.
Furness Technique.
Long-Term Outlook
Quality of Life
Renal Function
Bladder Function
Growth and Musculoskeletal Development
Sexual Function and Fertility
Suggested Readings
References
Chapter 33: Posterior Urethral Valves
Background
Description
Genetic Basis of Posterior Urethral Valves
Epidemiology
Pathophysiology of Posterior Urethral Valves
Lower Urinary Tract
Upper Urinary Tract
Vesicoureteral Reflux and Dysplasia
Diagnosis
Antenatal Diagnosis
Ultrasonography
Fetal Magnetic Resonance Imaging
Postnatal Diagnosis
Ultrasonography.
Voiding Cystourethrography
Voiding Urosonography (VUS)
Radionuclide Renal Scan
Laboratory Evaluation
Clinical Presentation and Initial Management
Antenatal Presentation and Management
Postnatal Management
Pulmonary Hypoplasia
Urinomas
Delayed Presentation
Surgical Intervention
Valve Ablation
Vesicostomy
Upper Tract Diversion
Circumcision
Nephroureterectomy
Management of Vesicoureteral Reflux
Bladder Dysfunction and Valve Bladder Syndrome
Bladder Management
Role of Urodynamics
Valve Bladder Syndrome
Prognostic Indicators for Renal Function
Transplantation in Valve Patients
Quality of Life With Posterior Urethral Valves
Anterior Urethral Valves
Urethral Atresia
Urethral Duplication
Urethrorrhagia
Urinary Fistula in Boys With Anorectal Malformation
Suggested Readings
References
Chapter 34: Neuromuscular Dysfunction of the Lower Urinary Tract in Children
Neural Tube Defects
Epidemiology of Neural Tube Defects
Risk Factors for the Development of Neural Tube Defects
Pathogenesis
Perinatal Concerns
Bladder Function After Prenatal Closure of Spina Bifida
Initial Postnatal Management
Findings
Prediction of Risk for Upper Urinary Tract Deterioration
Early Intervention in Children With Spina Bifida
Effect of Early Intervention on Bladder Function
Early Initiation of Clean Intermittent Catheterization Decreases the Rate of Urinary Tract Infection
Early Intervention Decreases Upper Urinary Tract Deterioration
Early Intervention Reduces the Rate of Vesicoureteral Reflux
Early Intervention Decreases the Need for Surgery
Early Intervention Decreases the Incidence of Renal Scarring and End-Stage Renal Disease
Assessment of Renal Function in Children With Neuromuscular Dysfunction of the Lower Urinary Tract
Kidney Size in Children With Spina Bifida
Renal Dysfunction in Spina Bifida
Determinants of Risk for Renal Dysfunction in Spina Bifida.
Sexual Function
Management of Neurogenic Bowel Dysfunction in Spina Bifida
Initial Diagnostic Evaluation and Follow-Up of Congenital Neurogenic Dysfunction in Children
Management of Neuromuscular Dysfunction of the Lower Urinary Tract
Medical Management of Neuropathic Dysfunction of the Lower Urinary Tract
Sympathomimetic Agents (Fig. 34.7)
Surgical Treatment Options for Neuropathic Dysfunction of the Lower Urinary Tract
Botulinum Toxin
Surgical Management of Neuropathic Dysfunction of the Lower Urinary Tract
Augmentation
Complications of Augmentation Cystoplasty.
Autoaugmentation
Urinary Diversion
Incontinent Urinary Diversion.
Urethral Dilation.
Bladder Neck Procedures
Artificial Urinary Sphincter.
Bladder Neck Slings.
Injection of Periurethral Bulking Agents
Electrostimulation
Sacral Neuromodulation
Artificial Somatic-Autonomic Reflex Pathway Procedure
Management of Vesicoureteral Reflux in Neuropathic Dysfunction of the Lower Urinary Tract
Lipomeningocele and Other Spinal Dysraphisms
Presentation
Pathogenesis
Specific Recommendations
Sacral Agenesis
Presentation
Pathogenesis
Specific Recommendations
Conditions of the Pelvis
Anorectal Malformations
Presentation
Pathogenesis
Specific Recommendations
Pelvic Surgery
Presentation
Pathogenesis
Specific Recommendations
Central Nervous System Insults
Presentation
Pathogenesis
Specific Recommendations
Conditions of the Brain (Tumors/Infarcts/Encephalopathies)
Presentation
Pathogenesis
Specific Recommendations
Conditions of the Spinal Cord
Traumatic Injuries
Presentation
Pathogenesis
Specific Recommendations
Tranverse Myelitis
Presentation
Pathogenesis
Specific Recommendations
Suggested Readings
References
Chapter 35: Functional Disorders of the Lower Urinary Tract in Children
Clinical Significance
Epidemiology
United States
International
Gender and Age-Related Demographics
Self-Esteem and Quality-of-Life Issues
Comorbidities
Urinary Tract Infections
Vesicoureteral Reflux
Psychological Associations
Bowel Dysfunction
Terminology
Daytime Urinary Incontinence and Bladder Dysfunction
Treatment
Urotherapy
Conservative Management
Bowel Dysfunction
Behavior Modification
Biofeedback
Clean Intermittent Catheterization
Pharmacotherapy
Anticholinergic Agents
α-Adrenergic Receptor Antagonists
Botulinum Toxin
Neuromodulation
Special Conditions of Lower Urinary Tract Dysfunction and Their Treatment
Giggle Incontinence (Enuresis Risoria)
Pollakiuria (Extraordinary Daytime Urinary Frequency)
Underactive Bladder
Vaginal Reflux (Vaginal Entrapment and Vaginal Voiding)
Enuresis
Terminology and Background
Epidemiology and Natural History
Genetics
Pathophysiology
Bladder Overactivity and Reduced Nocturnal Bladder Capacity
Nocturnal Polyuria
Arousal and Sleep
Evaluation
Treatment
Behavioral Therapy
Enuresis Alarm
Pharmacotherapy
Desmopressin
Tricyclic Antidepressants
Anticholinergics
Combination Therapy
Alternative Therapies
Suggested Readings
References
Chapter 36: Management of Defecation Disorders
Epidemiology and Classification of Disorders of Defecation
Normal Versus Abnormal Bowel Function
Evaluation of Abnormalities of Defecation
Imaging Studies
Management
Nonpharmacologic Interventions
Disimpaction and Large Bowel and Rectum Washout
Maintenance Therapy
Prognosis
Surgical Management
Nonsurgical Alternatives
Patient Selection and Preparation
Operative Technique
Enema Regimen
Surgical Outcomes
Suggested Readings
References
Chapter 37: Lower Urinary Tract Reconstruction in Children
“Functional” Urinary Tract
Dysfunction
Upper Urinary Tract
Bladder Dysfunction
Other Considerations
Patient Evaluation
Urodynamics
Bladder Dynamics: Capacity and Compliance
Sphincter Dynamics: Outflow Resistance
Bladder Emptying
Patient Preparation
Bowel Preparation
Urine Culture
Cystoscopy
Antireflux
Transureteroureterostomy and Single Ureteral Reimplant
Psoas Hitch
Antireflux With Intestinal Segments
Bladder Neck Reconstruction
Young-Dees-Leadbetter Repair
Technique
Results
Fascial Sling
Technique
Results
Bladder Neck Bulking Agents
Technique
Results
Artificial Urinary Sphincter
Technique
Results
Urethral Lengthening
Technique
Results
Pippi Salle Procedure
Technique
Results
Bladder Neck Division
Bladder Reconstruction
Cutaneous Vesicostomy
Augmentation Cystoplasty
Management of the Native Bladder
Management of Intestinal Segments
Ileocystoplasty
Technique
Cecocystoplasty and Ileocecocystoplasty
Technique
Appendix
Ileocecal Valve
Sigmoid Cystoplasty
Technique
Reconfiguration of Sigmoid.
Gastrocystoplasty
Postoperative Management
Early Management
Late Management
Results and Complications of Augmentation Cystoplasty
Gastrointestinal Effects
Bladder Compliance After Augmentation
Metabolic Complications
Chloride Absorption and Acidosis.
Patient Growth.
Alkalosis.
Hematuria-Dysuria Syndrome.
Mucus
Urinary Tract Infection
Calculi
Tumor Formation
Delayed Spontaneous Bladder Perforation
Etiology.
Incidence.
Treatment.
Pregnancy
Choice of Segment and Approach
A Decreasing Necessity?
Improving Quality of Life?
Ileovesicostomy
Technique and Results
Alternatives to Gastrointestinal Cystoplasty
Ureterocystoplasty
Technique.
Results.
Autoaugmentation
Techniques and Results.
Concerns.
Seromuscular Enterocystoplasty
Technique and Results.
Bladder Regeneration
Continent Urinary Diversion
Considerations
Continence Mechanisms and Catheterizable Stoma
Ureterosigmoidostomy and Its Variants
Nipple Valves
Flap Valves and the Mitrofanoff Principle
Technique.
Results.
Alternatives.
Ileocecal Valve
Hydraulic Valves
Continent Vesicostomy
Technique.
Results.
Results With Pediatric Continent Diversion
Other Considerations
Use of Buttons as Alternative Means to Empty Bladder
Technique.
Transitional Care Considerations
Summary
Suggested Readings
References
Section D: Upper Urinary Tract Conditions
Chapter 38: Anomalies of the Upper Urinary Tract
Anomalies of Renal Number
Bilateral Renal Agenesis
Incidence
Relevant Renal Embryology and Possible Etiology
Mammalian Kidney Organogenesis: New Advances in Developmental Biology
Gross Pathologic Description of Retroperitoneal Findings in Bilateral Renal Agenesis
Phenotypic Features Associated With Bilateral Renal Agenesis
Role of Amniotic Fluid Production in Fetal Pulmonary Development
Prenatal and Postnatal Diagnosis of Bilateral Renal Agenesis
Postnatal Radiographic Evaluation of a Neonate With Bilateral Renal Agenesis
Prognosis for the Patient With Bilateral Renal Agenesis
Unilateral Renal Agenesis
Incidence
Genetic/Syndromic and Other Associations
Embryology
Associated Genitourinary and Adrenal Anomalies
Anomalies in the Male
Anomalies in the Female
Anomalies of Other Organ Systems
Diagnosis and Radiographic Evaluation
Special Considerations
Prognosis
Current Concepts Regarding Prognosis in Adults With Unilateral Renal Agenesis
Supernumerary Kidney
Incidence
Embryology and Molecular Mechanisms Involved in Development of a Supernumerary Kidney
Description and Associated Anomalies
Associated Symptoms
Diagnosis
Anomalies of Renal Ascent
Simple Renal Ectopia
Incidence
Description and Associated Anomalies
Diagnosis
Prognosis
Cephalad Renal Ectopia
Thoracic Kidney
Incidence
Embryology
Description
Associated Anomalies
Symptoms
Diagnosis
Prognosis
Anomalies of Renal Form and Fusion
Crossed Renal Ectopia With and Without Fusion
Incidence
Embryology
Description
Inferior Ectopic Kidney
Sigmoid, or S-Shaped, Kidney
Cake, or Lump, Kidney
L-Shaped Kidney
Disc Kidney
Superior Ectopic Kidney
Associated Anomalies
Symptoms
Diagnosis
Prognosis
Horseshoe Kidney
Incidence
Description
Associated Anomalies
Symptoms
Diagnosis and Radiographic Appearance
Prognosis
Anomalies of Renal Rotation
Incidence
Description
Ventral Position
Ventromedial Position
Dorsal Position
Lateral Position
Symptoms
Diagnosis
Prognosis
Anomalies of Renal Vasculature
Aberrant, Accessory, or Multiple Vessels
Incidence
Embryology
Description
Symptoms
Diagnosis
Prognosis
Renal Artery Aneurysm
Renal Arteriovenous Fistula
Anomalies of the Renal Collecting System
Bifid Pelvis
Calyceal Diverticulum
Hydrocalycosis
Megacalycosis
Infundibulopelvic Stenosis
Acknowledgments
References
Chapter 39: Renal Dysgenesis and Cystic Disease of the Kidney
Overview of Genetics
Renal Agenesis and Dysplasia
Renal Agenesis
Renal Dysplasia
Definition
Etiology
Hypoplasia and Hypodysplasia
Renal Hypoplasia
Oligomeganephronia
Etiology
Clinical Features
Histopathology
Evaluation
Treatment
Ask-Upmark Kidney (Segmental Hypoplasia)
Clinical Features
Histopathology
Treatment
Renal Hypodysplasia
Cystic Diseases of the Kidney
Classification
Inheritable Cystic Disease
Autosomal Recessive (Infantile) Polycystic Kidney Disease
Genetics
Clinical Features
Histopathology
Evaluation
Treatment
Autosomal Dominant (Adult) Polycystic Kidney Disease
Genetics
Pathogenesis
Clinical Features
Extrarenal Manifestations
Association With Renal Cell Carcinoma
Histopathology
Evaluation
Treatment and Prognosis
Emerging Therapeutics
Juvenile Nephronophthisis and Medullary Cystic Disease Complex
Genetics
Clinical Features
Evaluation
Treatment
Other Inheritable Renal Cystic Diseases (Congenital Nephrosis)
Familial Hypoplastic Glomerulocystic Kidney Disease (Cortical Microcystic Disease)
Multiple Malformation Syndromes With Renal Cysts
Tuberous Sclerosis Complex
Genetics
Clinical Features
Association With Renal Cell Carcinoma
Radiographic Evaluation
Treatment
von Hippel-Lindau Disease
Etiology
Clinical Features
Classification
Histopathology
Evaluation
Screening
Treatment
Multicystic Dysplastic Kidney
Etiology
Clinical Features
Histopathology
Evaluation
Treatment and Prognosis
Benign Multilocular Cyst (Cystic Nephroma)
Clinical Features
Histopathology
Evaluation
Treatment
Simple Cysts
Clinical Features
Histopathology
Evaluation
Classification
Treatment and Prognosis
Medullary Sponge Kidney
Clinical Features
Histopathology
Diagnosis
Treatment and Prognosis
Sporadic Glomerulocystic Kidney Disease
Acquired Renal Cystic Disease
Etiology
Clinical Features
Histopathology
Evaluation
Treatment
Calyceal Diverticulum (Pyelogenic Cyst)
Parapelvic and Renal Sinus Cysts
Acknowledgment
Suggested Readings
References
Chapter 40: Pathophysiology of Urinary Tract Obstruction
Prevalence
Clinical Presentation of Obstruction
Clinical Presentation in Children
Progressive Renal Dysfunction
Definition of Obstruction
Diagnosis and Imaging
Laboratory Studies
Urinalysis
Fractional Excretion of Sodium
Assessment of Renal Function
Biomarkers
Diagnostic Imaging
Ultrasonography
Nuclear Renography
Computed Tomography
Magnetic Resonance Urography
Excretory Urography
Whitaker Test
Retrograde Pyelography
Antegrade Pyelography
Pathological Changes of Obstruction
Pathological Changes in the Mature Kidney
Pathological Changes in the Developing Kidney
General Observations
Growth
Growth Regulation of the Kidney.
Apoptosis Regulation.
Differentiation
Induction Process.
Tubulointerstitial Fibrosis
Inflammatory Cell Infiltration
Elaboration of Growth Factors and Cytokines
Transforming Growth Factor-β1 (TGF-β1)
Tumor Necrosis Factor-α
Interleukin-18
Angiotensin II
Fibrosis and Extracellular Matrix in Obstructive Nephropathy
Mechanisms of Fibrosis
Cytokine Regulation.
Epithelial-Mesenchymal Transition.
Dysregulation of the Proteolytic Balance.
Other Mechanisms.
Apoptosis.
Emerging Therapeutic Options
Hemodyamic Changes With Obstruction
Glomerular Filtration and Renal Blood Flow
Renal Vascular Resistance
Unilateral Ureteral Obstruction
Bilateral Ureteral Obstruction or Obstruction of a Solitary Kidney
Partial Ureteral Obstruction
Effects of Obstruction on Tubular Function
Urinary Concentrating Ability
Sodium Transport
Hydrogen Ion Transport and Urinary Acidification
Other Cation Transport
Egress of Urine From the Obstructed Kidney
Clinical Impact of Renal Obstruction
Hypertension
Compensatory Renal Growth
Treatment of Renal Obstruction
Pain Management
Renal Drainage
Renal Recovery After Obstruction
Choice of Surgical Intervention
Postobstructive Diuresis
Mechanism of Postobstructive Diuresis
Clinical Management of Postobstructive Diuresis
Experimental Modulation of Postobstructive Diuresis
Suggested Readings
References
Chapter 41: Ectopic Ureter, Ureterocele, and Ureteral Anomalies
Classification and Anatomic Description
General Patterns
Ectopic Ureter
Ureterocele
Embryology and Etiology
Ureteral-Trigonal-Renal Development
Clinical Presentation
Imaging
Prenatal Detection
Incidental Postnatal Detection
Infection
Incontinence
Pain
Prolapse
Late Presentation
Evaluation
Anatomic Assessment
Physical Examination
Ultrasonography
Voiding Cystourethrogram
Magnetic Resonance Imaging
Functional Assessment
Renal Function
Nuclear Imaging.
Intravenous Pyelogram.
Bladder Function
Ultrasound Imaging Interpretation
Ureterocele and Bladder Outlet
Endoscopic Evaluation
Clinical Management
Management Goals
Historical Perspective
Fetal Management
Neonatal Management
Nonurgent Management
Urgent Management
General Management Principles
Observational Management
Total Reconstruction
Upper Pole Partial Nephrectomy
Open Partial Nephrectomy or Heminephrectomy
Laparoscopic and Robotic Partial Nephrectomy
Ureteral Clipping
Outcomes
Complications.
Lower Tract Reconstruction
Ureterocele Excision and Common-Sheath Reimplantation
Pyeloureterostomy and Ureteroureterostomy
Open Procedure
Laparoscopic Procedure
Transurethral Incision for Ureterocele
Reflux Outcomes After Transurethral Incision
Ureterostomy for Ectopic Ureter
Summary of Clinical Decision Making
Voiding Dysfunction after Ureterocele Repair
Other Ureteral Anomalies
Anomalies of Number
Bifid Ureters
Triplication
Quadruple Ureters
Fibroepithelial Polyps
Anomalies of Position
Vascular Anomalies Involving the Ureter
Preureteral Vena Cava
Anatomy.
Embryology.
Incidence.
Diagnosis.
Treatment.
Other Anomalies of Position
Preureteral Iliac Artery (Retroiliac Ureter).
Vascular Obstruction of the Distal Ureter.
Herniation of the Ureter.
Suggested Readings
References
Chapter 42: Surgery of the Ureter in Children: Ureteropelvic Junction, Megaureter, and Vesicoureteral Reflux
Ureteropelvic Junction Obstruction
Definition
Clinical Presentation
Secondary Ureteropelvic Junction Obstruction
Lower Pole Ureteral Pelvic Junction Obstruction
Associated Anomalies
Surgical Indication
Surgical Repair
Dismembered Pyeloplasty
Nondismembered Pyeloplasty
Surgical Approach to Ureteral Pelvic Junction Obstruction
Posterior Lumbotomy
Flank Approach
Minimally Invasive Techniques
Endoscopic Approach
Laparoscopic Pyeloplasty
Transperitoneal or Retroperitoneal Approach.
Robotic-Assisted Pyeloplasty.
Technique of Laparoscopic or Robotic-Assisted Pyeloplasty.
Stones and Congenital Hydronephrosis.
Vascular Hitch.
Stenting
Outcome and Complications
Ureteral Strictures
Ureteral Polyps
Vesicoureteric Reflux
Definition and Clinical Presentation
Surgical Management
Incision
Intravesical Procedures
Politano-Leadbetter Technique
Glenn-Anderson Technique
Cohen Cross-Trigonal Technique
Extravesical Procedures
Minimally Invasive Procedures
Robotic-Assisted Laparoscopic Ureteral Reimplantation–Extravesical (RALUR-EV)
Postoperative Evaluation
Complications of Ureteral Reimplantation
Early Complications
Persistent Reflux.
Contralateral Reflux.
Obstruction.
Long-Term Complications
Obstruction.
Recurrent or Persistent Reflux.
Reoperative Reimplantation
Endoscopic Treatment of Vesicoureteral Reflux
Technique of Endoscopic Injection
Follow-Up
Materials Used for Endoscopic Correction of Reflux
Recurrence of Vesicoureteral Reflux After Endoscopic Correction
Megaureter
Definition
Etiology, Occurrence, and Presentation
Surgical Indications
Surgical Management
Outcomes
Dilation and Stenting
Suggested Readings
References
Chapter 43: Management of Pediatric Kidney Stone Disease
Extrarenal Manifestations
Evaluation
Child With Suspected Nephrolithiasis
Medical History and Physical Examination
Metabolic Investigations
Urinary Metabolic Abnormalities
Hypercalciuria
Hyperoxaluria
Primary Hyperoxaluria
Secondary Hyperoxaluria
Hypocitraturia
Cystinuria
Hyperuricosuria
Management of Children and Adolescents With Kidney and Ureteral Stones
Medical Expulsion Therapy
Surgical Management
Goals of Therapy
Stone Clearance Definition
Radiation
Ancillary Procedures/Anesthesia
Surgical Antimicrobial Prophylaxis
Ureteroscopic Management of Upper Urinary Tract Calculi
Equipment
Ureteroscopic Technique in Children
Limitations and Complications
Shock Wave Lithotripsy
Shock Wave Lithotripsy Technique in Children
Limitations and Concerns
Percutaneous Nephrolithotomy
Percutaneous Nephrolithotomy Planning for Pediatric Patients
Percutaneous Nephrolithotomy Technique for Pediatric Patients
Percutaneous Nephrolithotomy Complications
Laparoscopic and Robotic-Assisted Pyelolithotomy
Secondary Prevention
Fluid
Sodium
Calcium
Animal Protein
Oxalate
Citrate
Others
Medications
Diuretics
Alkali Agents
Thiol-Containing Agents
Allopurinol
Pyridoxine
References
Section E: Genitalia
Chapter 44: Management of Abnormalities of the External Genitalia in Boys
Normal Male External Genitalia
Embryology
Penile Length and Tanner Classification
Penile Anomalies
Prepuce (Foreskin)
Phimosis and Paraphimosis
Circumcision
Circumcision Complications.
Penile Skin Complications.
Glanular Adhesions and Skin Bridges.
Meatal Stenosis.
Penile Trauma.
Balanitis Xerotica Obliterans.
Abnormal Penile Number
Aphallia
Diphallia
Inconspicuous Penis
Buried Penis
Webbed Penis
Micropenis
Abnormal Penile Orientation
Penile Curvature
Penile Torsion
Penile Masses
Parameatal Urethral Cyst
Cyst of the Median Raphe
Inclusion Cysts
Congenital Penile Nevi
Juvenile Xanthogranuloma
Accessory Urethral Openings
Congenital Urethral Fistula
Urethral Duplication
Genital Lymphedema
Priapism
Penoscrotal Transposition (Scrotal Engulfment)
Scrotal Anomalies
Bifid Scrotum
Ectopic Scrotum
Scrotal Hypoplasia
Scrotal Agenesis
Scrotoschisis
Vascular Lesions of the Genitalia
Congenital Hemangiomas
Subcutaneous Hemangiomas
Klippel-Trénaunay-Weber Syndrome
Vascular Malformations
Hernia and Hydroceles
Embryology
Definitions (Fig. 44.27)
Epidemiology and Pathogenesis
Inguinal Hernia and Communicating Hydrocele
Noncommunicating Hydroceles
Genetics and Associated Conditions
Diagnosis
Signs and Symptoms
Physical Examination
Radiologic Imaging
Surgical Repair
Inguinal Hernia
Hydroceles
Standard Inguinal Hernia Repair
Complications
Scrotal Approach to Inguinal Hernia Repair
Laparoscopic Inguinal Hernia Repair
Assessment of the Contralateral Internal Ring
Abdominoscrotal Hydrocele
Acute Scrotum
Spermatic Cord Torsion
Acute Intravaginal Spermatic Cord Torsion
Predisposing Factors.
Clinical Presentation.
Diagnostic Studies.
Management and Surgical Treatment
Prognosis
Intermittent Intravaginal Spermatic Cord Torsion
Extravaginal Spermatic Cord Torsion (Perinatal Testicular Torsion)
Torsion of the Appendix Testis and Epididymis
Epididymitis
Other Causes of Acute Scrotal Pain
Varicocele
Epidemiology and Pathogenesis
Diagnosis and Classification
Associated Pathological Processes
Testicular Hypotrophy
Testicular Histology
Hormonal Function
Semen Quality
Intratesticular Varicocele
Treatment
Surgical Repair of Varicocele
Subinguinal or Inguinal Microsurgical Varicocelectomy
Retroperitoneal and Laparoscopic Varicocelectomy
Sclerotherapy or Embolotherapy
Epididymal and Vasal Anomalies
Suggested Readings
References
Chapter 45: Hypospadias
Embryology
Diagnosis of Hypospadias
Etiology of Hypospadias
Surgical Assessment
Preoperative Androgen Stimulation
Intraoperative Assessment and Management
Assessment and Management of Ventral Penile Curvature
General Considerations of Surgical Repair
Distal Hypospadias Repair
Advancement Procedures
Tubularization Techniques
Proximal Hypospadias
One-Stage Hypospadias Repair
Two-Stage Hypospadias Repair
Two-Stage Repair With Free Graft
Two-Stage Repair With Pedicle Flap
Comments on Proximal Hypospadias Repair
Postoperative Management
Complications of Hypospadias Repair
Urethrocutaneous Fistula
Glans Dehiscence
Meatal Stenosis
Urethral Stricture
Urethral Diverticulum
Balanitis Xerotica Obliterans
Recurrent Penile Curvature
Skin Complications
Hypospadias Outcomes
Outcome Assessment
Patient-Reported Outcomes
Hypospadias Reoperations
Future
Suggested Readings
References
Chapter 46: Etiology, Diagnosis, and Management of the Undescended Testis
Introduction
Definitions
Etiology
Embryology of Testicular Descent and Maldescent
Differentiation of the Testis
Testicular Hormone Production
Gubernacular Development and Testicular Descent
Regulation of Testicular Descent
Epidemiology
Congenital Cryptorchidism
Acquired Cryptorchidism
Pathogenesis
Genetic Susceptibility
Environmental Risk Factors
Hormonal Defects
Syndromic Cryptorchidism
Diagnosis
Examination
Palpable Testes
Nonpalpable Testes
Hormonal Evaluation
Imaging
Diagnostic Laparoscopy
Associated Pathology
Testicular Maldevelopment
Anomalies of the Epididymis, Processus Vaginalis, and Gubernaculum
Other Testicular Anomalies Associated With Cryptorchidism
General Guidelines for Management
Medical Management
Therapeutic LHRH and/or hCG
Adjuvant Hormonal Therapy
Surgical Management
Palpable Testes
Inguinal Orchidopexy
Transscrotal Orchidopexy (Video 46.2)
Abdominal Testes
Open Transabdominal Orchidopexy
Laparoscopic Orchidopexy and Fowler-Stephens Orchidopexy (Video 46.3)
Prognosis
Fertility
Testicular Cancer
Suggested Readings
References
Chapter 47: Management of Abnormalities of the Genitalia in Girls
Female Genital Embryology
Evaluation and Classification of Female Genital Anomalies
Congenital Disorders of Female External Genitalia
Disorders of the Clitoris
Hypertrophied Clitoris
Diminutive Clitoris
Disorders of the Vestibule
Urethral Prolapse
Urethral Polyp
Vestibular Cysts
Prolapsed Ureterocele
Ectopic Ureteral Insertion
Disorders of the Vagina
Imperforate Hymen and Hymenal Skin Tags
Abnormalities of Vertical Fusion
General.
Transverse Vaginal Septum.
Vaginal Atresia (Distal Vagina).
Vaginal Agenesis (Müllerian Aplasia).
Associated Findings
Vaginal Replacement Surgery
Creation of a Skin Neovagina.
Creation of an Intestinal Neovagina.
Special Considerations: Cervical Atresia
Abnormalities of Lateral Fusion
Duplication of the Uterus and Cervix With Unilaterally Imperforate Vagina (Herlyn-Werner-Wunderlich Syndrome).
Acquired Disorders of the Female External Genitalia
Rhabdomyosarcoma
Labial Adhesions
Female Circumcision (Infibulation)
Condyloma Acuminata
Inguinal Hernias
Suggested Readings
Embryology
Disorders of the Vestibule
Abnormalities of Vertical MÜllerian Fusion
Vaginal Agenesis Management
Female Genital Mutilation
References
Chapter 48: Disorders of Sexual Development: Etiology, Evaluation, and Medical Management
Normal Sexual Development
Normal Genotypic Development
Chromosomal Sex
SRY
Additional Genes Involved in Gonadal Determination
WT1.
NR5A1 (SF1).
SOX9.
NR0B1 (DAX1) and Dosage-Sensitive Sex Reversal (DSS).
WNT4.
RSPO1.
Normal Phenotypic Development
Gonadal Stage of Differentiation
Gonadal Function
Testis
Ovary
Phenotypic Sexual Development
Gender Identity, Gender Role, and Gender Orientation
Psychosexual Development
Abnormal Sexual Development
Evaluation and Management of the Newborn With Ambiguous Genitalia
Gender Assignment
Disorders of Gonadal Differentiation and Development
Klinefelter Syndrome and Variants
46,XX Males
Syndromes of Gonadal Dysgenesis
Turner Syndrome.
46,XX “Pure” Gonadal Dysgenesis.
Mixed Gonadal Dysgenesis.
Partial Gonadal Dysgenesis.
46,XY Complete (Pure) Gonadal Dysgenesis (Swyer Syndrome).
Embryonic Testicular Regression and Bilateral Vanishing Testes Syndromes
Ovotesticular DSD
46,XX DSD (Masculinized Female)
Congenital Adrenal Hyperplasia
46,XX DSD (Masculinized Female) Secondary to Maternal Androgens and Progestins and Maternal Tumors
46,XY DSD (Undermasculinized Male)
Leydig Cell Aplasia (Luteinizing Hormone Receptor Abnormality)
Disorders of Testosterone Biosynthesis
Congenital Lipoid Adrenal Hyperplasia (StAR Deficiency).
Cytochrome P450 Oxidoreductase Deficiency.
3β-Hydroxysteroid Dehydrogenase Deficiency.
17α-Hydroxylase Deficiency.
17,20-Lyase Deficiency.
17β-Hydroxysteroid Oxidoreductase Deficiency.
Androgen Receptor and Postreceptor Defects
Syndrome of Complete Androgen Insensitivity.
Syndrome of Partial Androgen Resistance.
Mild Androgen Insensitivity Syndrome.
5α-Reductase Deficiency
Persistent Müllerian Duct Syndrome
Unclassified Forms: Mayer-Rokitansky- Küster-Hauser Syndrome
Future Directions
Collaborative Networking
Impact of DSD Diagnosis on Caregivers
Ethical Considerations
Suggested Readings
References
Normal Sexual Differentiation
Abnormal Sexual Differentiation
Evaluation and Management of the Newborn with Ambiguous Genitalia
Gender Assignment
Disorders of Gonadal Differentiation and Development
46,XX Males
Syndromes of Gonadal Dysgenesis
46,XX “Pure” Gonadal Dysgenesis
Mixed Gonadal Dysgenesis
Partial Gonadal Dysgenesis (Dysgenetic Male Pseudohermaphroditism)
46,XY Complete (Pure) Gonadal Dysgenesis (Swyer Syndrome)
Embryonic Testicular Regression and Bilateral Vanishing Testes Syndromes
Ovotesticular DSD (True Hermaphroditism)
46,XX DSD (Masculinized Female)
46,XX (Masculinized Female) Secondary to Maternal Androgens and Progestins and Maternal Tumors
46,XY DSD (Undermasculinized Male)
Disorders of Testosterone Biosynthesis
Androgen Receptor and Postreceptor Defects
Syndrome of Partial Androgen Resistance
5α-Reductase Deficiency
Persistent Müllerian Duct Syndrome
Mayer-Rokitansky-Küster-Hauser Syndrome
Future Directions
Impact on Caregivers
Ethical Considerations
Section F: Reconstruction and Trauma
Chapter 49: Surgical Management of Differences of Sexual Differentiation and Cloacal and Anorectal Malformations
Classification of Urogenital Sinus and Cloacal Anomalies
Evaluation
History and Physical Examination
Radiographic and Endoscopic Evaluation
Urogenital Sinus Abnormalities
Cloacal Anomalies
Surgical Reconstruction of Disorders of Sex Development and Urogenital Sinus
Initial Management, Timing, and Principles
Current Operative Techniques for Female Disorders of Sex Development and Urogenital Sinus Repair
Low Vaginal Confluence: Clitoral Hypertrophy
High Vaginal Confluence: With or Without Clitoral Hypertrophy
Total and Partial Urogenital Mobilization
Results of Urogenital Sinus and Disorders of Sex Development Surgery
Surgical Reconstruction for Cloacal Malformations
Initial Management, Timing, and Principles
Decompression of the Gastrointestinal Tract
Decompression of the Genitourinary Tract
Repair of Obstructive Urinary and Other Pathology
Definitive Repair of Cloacal Malformations
Operative Technique: Cloaca
Results of Cloacal Surgery
Summary
Suggested Readings
References
Chapter 50: Adolescent and Transitional Urology
Definitions
Transition
Failure of Transition
Transfer
Models for Transition
Patient Population
Setting Up a Service
Training
The Multidisciplinary Team
Institutional and Political Support
Barriers to Transition
Institutional
Professional
Patients
Expanding Numbers and Management of the Service Long-Term
The Importance of Specialist Nurses
Clinical Delivery
Geography
The Clinic
Patient/Parent Preparation for Transition
What Does Success Look Like?
The Price of Failure
Clinical Practice: Major Diagnoses
Functional Assessment of the Reconstructed Urinary Tract
Video-Urodynamics
Flow Rates
Renography
Ultrasonography
Blood Tests
Hypospadias
Exstrophy
Long-Term Reconstructive Outcomes
Urologic
Male
Penile Concerns and Management
Sexual Function
Fertility
Females Born With Exstrophy
Reconstruction of the Genitalia
Procedentia Repair
Female Sexual Function
Fertility
Pregnancy and Delivery
Spina Bifida: the Neuropathic Bladder
Changes in Bladder Function and Continence
Renal and Urologic Concerns
Sex and Sexuality
Preparation for Pregnancy
Posterior Urethral Valves
Sexual Function and Fertility
Summary
Suggested Readings
References
Chapter 51: Urologic Considerations in Pediatric Renal Transplantation
Pretransplant Assessment
Screening
Focused Assessment
Pretransplant Preparation
Bladder Preparation
General Issues
Hypertonicity and Poor Compliance
Capacity
Infections
Clean Intermittent Catheterization
Defunctionalized Bladder
Neuropathic.
Non-Neuropathic.
Decision to Augment.
Cutaneous Stomas
Reconstruction Strategies
Dialysis Issues
Graft Placement
Timing
Enterocystoplasty
Native Nephrectomy
Managing Patients With Native Kidneys
Avoiding Removal
Limit Risk of Infection
Ureteral Preservation
Combining Nephrectomy and Transplant
Transplantation
Ureteral Anastomosis
Surgical Techniques and Options
Ureteral Stenting
Complications
Urine Leaks
Infection
Reflux
Hydronephrosis and Obstruction
Bladder Dysfunction
Stones
Summary
Suggested Readings
References
Chapter 52: Pediatric Genitourinary Trauma
Renal Injuries
Epidemiology
Presentation
Indications for Renal Imaging
Imaging Studies for Diagnosis
As Low as Reasonably Achievable
Focused Assessment With Sonography for Trauma
Dedicated Renal Ultrasonography
Computed Tomography
Classification and Grading of Renal Injuries
AAST Grading System
High-Risk Criteria
Blunt Versus Penetrating
Management
Nonoperative
Nonoperative Management Protocol
Early Repeat Imaging
Outcomes of Nonoperative Management
Management of Complications in Nonoperative Patients
Persistent Urine Leak
Indications for Intervention for Urine Leak or Urinoma
Ureteral Stent
Percutaneous Drain
Nephrostomy Tube
Angioembolization of Isolated Renal Segment
Renal Exploration With Repair of Urine Leak
Persistent or Delayed Bleeding
Indications for Angioembolization
Renal Exploration
Operative
Indications
One-Shot intraoperative Intravenous Pyelography or Ultrasonography
Control of Renal Vasculature
Reconstruction Versus Nephrectomy
Renal Arterial Laceration
Renal Arterial Occlusion
Ureteropelvic Junction Disruption
Renal Pelvis Rupture
Congenital Anomalies and Renal Injuries
Ureteropelvic Junction Obstruction
Duplex Kidney
Fusion Anomalies and Ectopic Kidney
Follow-Up and Long-Term Issues
Late Repeat Imaging and Assessment of Renal Function
Hypertension
Chronic Flank Pain
Chronic Kidney Disease
Follow-Up and Activities With a Solitary Kidney
Ureteral Trauma
Epidemiology
Presentation
Imaging Findings
American Association for the Surgery of Trauma Classification
Management of Traumatic Ureteral Injury
Immediate Diagnosis
Delayed Diagnosis
Proximal or Mid-Ureteral Injury Surgical Repair
Distal Ureteral Injury Surgical Repair
Lengthy Ureteral Injuries
Follow-Up Imaging
Bladder Injuries
Presentation
Pelvic Fracture
Imaging
Management
Urethral Injuries
Evaluation
Management
Urethral Disruption in Females
Genital Injury in the Pediatric Population
Penile Injury
Scrotal Injury
Epidemiology
Imaging
Management
Vaginal Injury
Management
References
Section G: Oncology
Chapter 53: Pediatric Urologic Oncology: Renal and Adrenal
Neuroblastoma
Epidemiology and Genetics
Incidence
Genetics
Constitutional Chromosome Abnormalities
Embryology and Spontaneous Regression
Pathology
Clinical Presentation and Pattern of Spread
Diagnosis
Laboratory Evaluation
Imaging
Screening
Staging
Prognostic Factors
Clinical Variables
Biologic Variables
Treatment
Surgery
Low-Risk Disease (Stages I, II, and IV-S).
Perinatal Neuroblastoma.
Intermediate and High-Risk Disease (Stages III and IV).
Chemotherapy
New Innovative Biologic Therapies
Radiotherapy
Spinal Cord Compression
Wilms Tumor
Epidemiology
Biology/Genetics
WT1
WTX
11p15
Familial Wilms Tumor
Other Chromosomal Abnormalities
Screening
Pathology
Favorable Histology Wilms Tumor
Anaplastic Wilms Tumor
Pathology After Preoperative Chemotherapy
Nephrogenic Rests
Preoperative Evaluation and Staging
Imaging
Staging
Prognostic Factors
Chromosomal Abnormalities.
Treatment
Surgical Considerations
Cooperative Group Trials
National Wilms Tumor Study Group.
Children’s Oncology Group.
International Society of Paediatric Oncology.
United Kingdom Children’s Cancer Study Group.
Adult Wilms Tumor
Relapse
Preoperative Chemotherapy (COG Recommendations)
Inoperable Tumors.
Bilateral Wilms Tumors.
Partial Nephrectomy for Unilateral Tumors.
Late Effects of Treatment
Mortality
Fertility and Pregnancy
Second Malignancies
Cardiac Effects
Other Renal Tumors
Clear Cell Sarcoma of the Kidney
Rhabdoid Tumor of the Kidney
Congenital Mesoblastic Nephroma
Solitary Multilocular Cyst and Cystic Partially Differentiated Nephroblastoma
Metanephric Adenofibroma
Renal Cell Carcinoma
Angiomyolipoma
References
Neuroblastoma
Nephroblastoma
Chapter 54: Pediatric Urologic Oncology: Bladder and Testis
Epidemiology and Syndromic Associations
Pathology and Molecular Biology
Presentation, Initial Evaluation and Management, Staging
Presenting Symptoms and Examination
Evaluation
Biopsy Techniques and Management of Obstruction
Staging and Childrens Oncology Group Risk Group Assignment
Treatment and Outcomes
Evolution of Multimodal Treatment
Current Multi-Model Approaches: Children’s Oncology Group
Current Multi-Model Approaches: European Cooperative Groups
Local Control
Treatment of Very Young Children
Timing of Surgical Reconstruction
Outcomes
Late Effects
Oncofertility
Other Bladder Tumors
Transitional Cell Carcinoma
Cancer in the Augmented Bladder
Urachal Carcinoma
Adenocarcinoma and Squamous Cell Carcinoma
Benign Bladder Tumors
Female Genital Tract
Tumors of the Vulva and Clitoris
Vaginal Rhabdomyosarcoma
Cervical or Uterine Rhabdomyosarcoma
Ovarian Lesions
Cystic Lesions
Ovarian Malignancies
Germ Cell Tumors
Sex Cord Tumors
Epithelial Tumors
Testicular Tumors
Epidemiology
Pathogenesis and Molecular Biology
Presentation, Evaluation, and Staging
Ultrasonography
Interpretation of Biomarkers in Children
Staging
Tumors Associated With Disorders of Sexual Development
Germ Cell Tumors
Gonadal Stromal Tumors
Leukemia and Lymphoma
Testicular Microlithiasis
Management Algorithms
Testis-Sparing Surgery Technique
Paratesticular Rhabdomyosarcoma
Presentation and Staging
Treatment
Role of Retroperitoneal Lymph Node Dissection
Outcomes
Perineal Rhabdomyosarcoma
Suggested Readings
References
Part IV: Infections and Inflammation
Chapter 55: Infections of the Urinary Tract
Definitions
Incidence and Epidemiology
Pathogenesis
Routes of Infection
Ascending Route
Hematogenous Route
Lymphatic Route
Urinary Pathogens
Fastidious Organisms
Anaerobes in the Urinary Tract
Mycobacterium tuberculosis and Other Nontuberculous Mycobacteria
Chlamydia
Bacterial Virulence Factors
Early Events in Uropathogenic E. coli Pathogenesis
Bacterial Adherence
Bacterial Adhesins.
Type 1 (Mannose-Sensitive) Pili.
P (Mannose-Resistant) Pili.
Other Adhesins.
Catch Bonds.
Phase Variation of Bacterial Pili in vivo
Epithelial Cell Receptivity
Vaginal Cells
Variation in Receptivity.
Bladder Cells
Uropathogenic E. coli Persistence in the Bladder.
Natural Defenses of the Urinary Tract
Periurethral and Urethral Region
Urine
Bladder
Immune Response
Pathogen Recognition.
Toll-Like Receptor Signaling.
Induced Exfoliation.
Alterations in Host Defense Mechanisms
Obstruction
Vesicoureteral Reflux
Underlying Disease
Diabetes Mellitus
Renal Papillary Necrosis
Human Immunodeficiency Virus
Other Conditions That Increase Risk of Urinary Tract Infections
Renal Transplantation
Menopause
Pregnancy
Spinal Cord Injury With High-Pressure Bladders
Evaluation
Signs and Symptoms
Diagnosis by Urine Testing
Urine Collection
Key Issues in Analysis of Urine Samples.
Urine Dipsticks.
Urinalysis.
Urine Culture.
Localization
Ureteral Catheterization
Stone Cultures
Imaging
Ultrasonography
Computed Tomography and Magnetic Resonance Imaging
Voiding Cystourethrogram
Radionuclide Studies
Microbiome
Asymptomatic Bacteriuria
Principles of Antimicrobial Therapy
Ecologic Impact and Collateral Damage
Antimicrobial Formulary
Nitrofurantoin
Trimethoprim-Sulfamethoxazole
Fosfomycin
Fluoroquinolones
Cephalosporins
Aminopenicillins
Aminoglycosides
Aztreonam
Pivmecillinam
Choice of Antimicrobial Agents
Duration of Therapy
Bladder Infections
Uncomplicated Cystitis
Clinical Presentation
Laboratory Diagnosis
Management
Antimicrobial Selection.
Duration of Therapy.
Cost of Therapy.
Follow-Up
Compliance With Recommended Agents.
Complicated Urinary Tract Infections
Emphysematous Cystitis
Clinical Presentation.
Radiologic Findings.
Management.
Unresolved Urinary Tract Infections
Clinical Presentation
Laboratory Diagnosis
Management
Recurrent Urinary Tract Infections
Evaluation
Bacterial Persistence
Management
Behavioral Modification.
Self-Start Therapy.
Low-Dose Continuous Prophylaxis.
Non-Antibiotic Management.
Cranberry.
Estrogen.
Probiotics.
Methenamine.
D-Mannose.
Immunoactive Prophylaxis.
Kidney Infections
Renal Infection (Bacterial Nephritis)
Pathology
Acute Pyelonephritis
Clinical Presentation.
Laboratory Diagnosis.
Bacteriology.
Renal Ultrasonography, Computed Tomography, and Magnetic Resonance Imaging.
Differential Diagnosis.
Management
Initial Management.
Subsequent Management.
Unfavorable Response to Therapy.
Follow-Up.
Acute Focal or Multifocal Bacterial Nephritis
Clinical Presentation.
Radiologic Findings.
Management.
Emphysematous Pyelonephritis
Clinical Presentation.
Radiologic Findings.
Management.
Renal Abscess
Clinical Presentation.
Laboratory Diagnosis.
Management.
Infected Hydronephrosis and Pyonephrosis
Clinical Presentation.
Radiologic Findings.
Management.
Perinephric Abscess
Clinical Presentation.
Management.
Perinephric Abscess Versus Acute Pyelonephritis.
Chronic Pyelonephritis
Clinical Presentation.
Radiologic Findings.
Pathology.
Management.
Bacterial “Relapse” From a Normal Kidney
Infectious Granulomatous Nephritis
Xanthogranulomatous Pyelonephritis
Pathogenesis.
Pathology.
Clinical Presentation.
Bacteriology and Laboratory Diagnosis.
Differential Diagnosis.
Management.
Malacoplakia
Pathogenesis.
Pathology.
Clinical Presentation.
Radiologic Findings.
Differential Diagnosis.
Management.
Renal Echinococcosis
Pathogenesis and Pathology.
Clinical Presentation.
Laboratory Diagnosis.
Radiologic Findings.
Management.
Other Infections
Fournier Gangrene
Clinical Presentation
Laboratory Diagnosis and Radiologic Findings
Management
Outcome
Periurethral Abscess
Pathogenesis
Clinical Presentation
Management
Bacteremia, Sepsis, and Septic Shock
Definitions
Pathophysiology
Bacterial Cell Wall Components in Septic Shock
Cytokine Network
Clinical Presentation and Diagnosis
Bacteriology
Management
Bacteriuria in Pregnancy
Pregnancy
Pathogenesis
Anatomic and Physiologic Changes During Pregnancy
Increase in Renal Size
Smooth Muscle Atony of the Collecting System and Bladder
Bladder Changes
Augmented Renal Function
Complications Associated With Bacteriuria During Pregnancy
Prematurity and Prenatal Mortality
Maternal Anemia
Laboratory Diagnosis
Management
Pregnancy in Women With Renal Insufficiency
Bacteriuria and Urinary Tract Infections in the Elderly
Epidemiology
Screening for Bacteriuria
Pathogenesis
Diagnosis
Management
Catheter-Associated Urinary Tract Infection
Pathogenesis
Clinical Presentation
Laboratory Diagnosis
Management
Management of Urinary Tract Infections in Patients With Spinal Cord Injury
Epidemiology
Pathogenesis
Clinical Presentation
Bacteriology and Laboratory Diagnosis
Management
Kidney Transplant Recipients
Antimicrobial Prophylaxis for Common Urologic Procedures
Principles of Surgical Antimicrobial Prophylaxis
Urethral Catheterization and Removal
Urodynamics
Transrectal Ultrasound-Guided Prostate Biopsy
Shock-Wave Lithotripsy
Endoscopic Procedures: Lower Urinary Tract
Simple Cystoscopy (Without Manipulation)
Transurethral Resection of the Prostate and Bladder (Cystourethroscopy With Manipulation)
Endoscopic Procedures: Upper Urinary Tract
Ureteroscopy
Ureteral Stenting
Percutaneous Renal Surgery (Prophylaxis Indicated in All Patients)
Open, Laparoscopic, and Robotic Surgery
Skin Preparation for Surgery
Vaginal Surgery
Special Considerations
Patients With Risk of Endocarditis
Patients With Indwelling Orthopedic Hardware
Acknowledgments
References
Chapter 56: Inflammatory and Pain Conditions of the Male Genitourinary Tract: Prostatitis and Related Pain Conditions, Orchitis, and Epididymitis
Prostatitis
Historical Perspective
Current Classification of Prostatitis
NIH Classification
Histopathology
Histology
Specific Cases of Prostatic Inflammation
Granulomatous Prostatitis
Immunoglobulin G Subclass 4 (IgG4)
Category I Prostatitis: Acute Bacterial Prostatitis
Microbiology.
Evaluation.
Treatment.
Adjuncts to Antibiotic Therapy.
Prostatic Abscess
Category II: Chronic Bacterial Prostatitis
Bacteria-Causing Category II Prostatitis.
Role of Chlamydia in Prostatitis?
Diagnosis and Evaluation.
Treatment of Chronic Bacterial Prostatitis (Category II).
CP II in HIV/Immunocompromised Patients.
Beyond Quinolones.
Etiology
Infection
Inflammation
Neurologic Causes
Pelvic Floor Dysfunction
Psychosocial Factors
Endocrine Abnormalities
Genetics
Biomarkers
Abnormal Sensory Processing
Symptoms in Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Prevalence of Individual Symptoms in Men With Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Summary of Findings From the Multidisciplinary Approach to Pelvic Pain Study
Fluctuations in Symptom Severity
Sexual Dysfunction
Anxiety and Depression
Association With Other Medical Diseases
Cardiovascular Disease.
Neurologic Disease.
Phenotypic Approach to Symptoms and Symptom Clustering: UPOINT
Evaluation of Chronic Prostatitis and Chronic Pelvic Pain Syndrome
History
Assessment
Pain.
Other Urologic Symptoms
Review of Symptoms
Physical Examination
Laboratory/Office Studies
Treatment of Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Pharmacologic Treatment
Antibiotic Treatment.
Summary of Treatment Recommendations.
Alpha-Blocker Treatment.
Anti-Inflammatory Therapy.
Reductase Inhibitors.
Medications for Neuropathic Pain.
Phototherapy.
Bladder Specific: Pentosan Polysulfate.
Other Medications
Allopurinol.
Mepartricin.
PDE5 Inhibitors.
Other Treatments for Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Conservative
Lifestyle Changes: Diet and Exercise.
Stress Management/Psychological Treatments.
Acupuncture.
Minimally Invasive Therapies
Pelvic Floor Physical Therapy and Skeletal Muscle Relaxants.
Adjuncts to Pelvic Floor Physical Therapy.
Prostate Massage.
Circumcision.
Prostate-Specific Treatments
Local Hyperthermia and Needle Ablation.
Intraprostatic Injection of Onabotulinumtoxin A.
Surgical Therapy for Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Surgical Therapy for Bladder Neck Hypertrophy.
Neurostimulation.
Electromagnetic Stimulation.
Cystoscopy and Fulguration of Hunner’s Ulcer.
Not Recommended: Radical Prostatectomy.
Cochrane Review of Nonpharmacological Interventions for Treating Chronic Prostatitis and Chronic Pelvic Pain Syndrome
Treatment: Summary and Approach
Acute and Chronic Orchitis and Orchialgia
Acute Orchitis
Etiology
Evaluation
Treatment
Chronic Scrotal Pain Syndrome: Orchialgia
Epidemiology
Cause of Chronic Orchialgia
Evaluation
Therapy for Idiopathic Orchialgia and Chronic Scrotal Pain Syndrome
Medical Therapies.
Spermatic Cord Block.
Acute and Chronic Epididymitis (Epididymalgia)
Acute Epididymitis.
Etiology.
Clinical Evaluation.
Treatment.
Follow-Up.
Chronic Epididymitis.
Etiology.
Evaluation.
Treatment.
Tubercular Epididymitis
Nonmedical Therapy for Chronic Scrotal Pain: Chronic Orchitis (Orchalgia) and Chronic Epididymitis (Epididymalgia)
Minimally Invasive Treatments
Pelvic Floor Physical Therapy.
Botox.
Pulsed Radiofrequency of the Spermatic Cord.
Nonradical Surgical Treatments
Neuromodulation
Surgical Therapy
Surgical Therapy for Orchalgia in Patients With Identifiable Intrascrotal Lesions
Vasovasostomy or Vasoepididymostomy for Treatment of Postvasectomy Pain
Microsurgical Denervation of the Spermatic Cord
Epididymectomy for Chronic Pain
Orchiectomy for Chronic Scrotal Pain
References
Chapter 57: Interstitial Cystitis/Bladder Pain Syndrome and Related Disorders
A Brief History and Overview
Definition, Nomenclature, and Taxonomy
Interstitial Cystitis/Bladder Pain Syndrome Research Criteria and Their Influence on Clinical Practice
Historical Perspective of Interstitial Cystitis/Bladder Pain Syndrome: Early 1800S to 1970S
Voiding Symptoms and Interstitial Cystitis/Bladder Pain Syndrome
Epidemiology of Interstitial Cystitis/Bladder Pain Syndrome
Interstitial Cystitis/Bladder Pain Syndrome in Children
The Epidemiology of Hunner Lesions
Heredity and Interstitial Cystitis/Bladder Pain Syndrome
Natural History, Effects on Quality of Life, and Economic Burden
Abuse and Symptoms
Medical Costs
Associated Disorders
Etiology
Animal Models
Infection
Autoimmunity and Inflammation
Mast Cell Involvement
Bladder Glycosaminoglycan Layer and Epithelial Permeability
Inhibition of Uroepithelial Cell Proliferation: Antiproliferative Factor
Neurobiology
Pelvic Organ Cross-Sensitization
Nitric Oxide Metabolism
Urine Abnormalities
Role of Genetics in Bladder Pain Syndrome
Other Potential Causes
Pathology
Diagnosis
Ketamine Cystitis
High-Tone Pelvic Floor Dysfunction
Beyond the History, Physical Examination, and Urine Studies
The Voiding Diary
Symptom Scales for Clinical Assessment and Research
Urodynamic Evaluation
Office Cystoscopy
Cystoscopy With Hydrodistention and Biopsy
The Search for a Marker
Potassium Chloride Test
Treatment of Interstitial Cystitis/Bladder Pain Syndrome
General Principles of Therapy
Conservative Therapies
Diet
The Role of Patient Support Groups
Oral Therapies (Table 57.6)
Amitriptyline
Antihistamines
Montelukast
Pentosan Polysulfate Sodium
Immunomodulator Drugs
Cyclosporine A.
Other Immunoregulating Agents.
Miscellaneous Agents
l-Arginine.
Quercetin.
Antibiotics.
Nifedipine.
Misoprostol.
Dextroamphetamine.
Phosphodiesterase Inhibitors.
Gabapentin.
Intravesical Therapies
Silver Nitrate
Clorpactin
Dimethyl Sulfoxide
Glycosaminoglycans
Other Intravesical Therapies
Sodium Channel Blocking Anesthetics (Lidocaine).
Intradetrusor Therapy
Onabotulinum Toxin-A (BTX-A).
Neuromodulation
Surgical Therapy
Hydrodistention
Surgical Considerations
Historical Procedures
Surgery for Hunner Lesion
Major Surgical Procedures
“Less Is More”
Final Thoughts
Suggested Readings
References
Chapter 58: Sexually Transmitted Diseases
Epidemiology of Sexually Transmitted Diseases
Clinical Prevention Guidance
Screening Recommendations
Young or at-Risk Women
Pregnant Women
Persons in Correctional Facilities
Men Who Have Sex With Men
Transgender Men and Women
Reporting Sexually Transmitted Disease
Prevention Methods
Urethritis
Etiology
Diagnosis
Gonococcal Urethritis
Diagnosis of Gonococcal Urethritis
Treatment of Gonococcal Urethritis
Nongonococcal Urethritis
Chlamydia
Mycoplasma Genitalium
Trichomaonas Vaginalis
Persistent or Recurrent Nongonoccal Urethritis
Epididymitis
Diagnosis of Epididymitis
Treatment of Epididymitis
Genital, Anal, and Perianal Ulcers
Genital Herpes Simplex Virus Infections
Pathophysiology of Genital Herpes
Presentation of Genital Herpes
Diagnosis of Genital Herpes
Treatment of Genital Herpes
Syphilis
Primary Syphilis
Secondary Syphilis
Latent Syphilis
Tertiary Syphilis
Diagnosis of Syphilis
Darkfield Examination
Serology
Nontreponemal Tests
Treponemal Tests
Treatment for Syphilis
Chancroid
Granuloma Inguinale (Donovanosis)
Lymphogranuloma Venereum
Molluscum Contagiosum
Anogenital Warts
Human Papillomavirus
Presentation and Diagnostic Considerations
Treatment of Anogenital Warts
Human Papillomavirus Vaccine
Zika Virus
Transmission of Zika Virus
Symptoms
Diagnosis
Preconception Counseling and Prevention of Sexual Transmission of Zika Virus
Treatment for Zika Virus Infections
Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS)
Diagnosis of Human Immunodeficiency Virus
Decreasing the Transmission Risk
Male Circumcision
Postexposure Prophylaxis
Pre-Exposure Prophylaxis
Urologic Manifestations of HIV/AIDS
HIV and Other STDs
Nonulcerating Skin Infections
Urinary Tract Infections
Renal Infections
Prostatitis
Testis, Epididymis, and Seminal Vesicles
Nephrolithiasis
Renal Dysfunction
Voiding Dysfunction
Erectile Dysfunction
Malignancy
Kaposi Sarcoma
Non–AIDS-Defining Urologic Malignancies
Testicular Tumors
Prostate Cancer
Renal Cell Carcinoma
Bladder Cancer
Penile Cancer
Viral Hepatitis
Hepatitis B
Diagnosis
Screening
Treatment
Prevention
Counseling Patients Who Are HBsAg Positive
Vaccination
Postvaccination Serologic Testing for Response
Postexposure Prophylaxis
Postexposure in a Previously Vaccinated Health Care Worker
Postexposure in an Unvaccinated or Incompletely Vaccinated Health Care Worker
Clinical Management of the Health Care Worker Exposed to HBV
Hepatitis C
Diagnosis
Occupational HCV Exposure in the Health Care Worker
Treatment
Ectoparasitic Infections
Pediculosis Pubis (Phthirus Pubis): Pubic or Crab Louse
Scabies
Vaginitis
Bacterial Vaginosis
Trichomoniasis
Candidiasis
References
Chapter 59: Cutaneous Diseases of the External Genitalia
Introduction to Basic Dermatology
Dermatologic Therapy
Allergic Dermatitis
Atopic Dermatitis (Eczema)
Contact Dermatitis
Erythema Multiforme and Stevens-Johnson Syndrome
Papulosquamous Disorders
Psoriasis
Reactive Arthritis (Formerly Reiter Syndrome)
Lichen Planus
Lichen Nitidus
Lichen Sclerosus
Fixed Drug Eruption
Seborrheic Dermatitis
Vesicobullous Disorders
Pemphigus Vulgaris
Bullous Pemphigoid
Dermatitis Herpetiformis and Linear IgA Bullous Dermatosis
Hailey-Hailey Disease
Noninfectious Ulcers
Aphthous Ulcers and Behçet Disease
Pyoderma Gangrenosum
Traumatic Causes
Infections and Infestations
Sexually Transmitted Diseases
Balanitis and Balanoposthitis
Cellulitis and Erysipelas
Fournier Gangrene (Necrotizing Fasciitis of the Perineum)
Folliculitis
Furunculosis
Hidradenitis Suppurativa (Acne Inversa)
Corynebacterial Infection (Trichomycosis Axillaris and Erythrasma)
Ecthyma Gangrenosum
Genital Bite Wounds
Candidal Intertrigo
Dermatophyte Infection
Infestation
Neoplastic Conditions
Squamous Cell Carcinoma in Situ
Bowenoid Papulosis
Squamous Cell Carcinoma
Verrucous Carcinoma (Buschke-Lowenstein Tumor)
Basal Cell Carcinoma
Kaposi Sarcoma
Pseudoepitheliomatous, Keratotic, and Micaceous Balanitis
Melanoma
Extramammary Paget Disease
Cutaneous T-Cell Lymphoma
Benign Cutaneous Disorders Specific to the Male Genitalia
Angiokeratoma of Fordyce
Pearly Penile Papules
Zoon Balanitis
Sclerosing Lymphangitis
Median Raphe Cysts
Ectopic Sebaceous Glands
Common Miscellaneous Cutaneous Disorders
Skin Tag
Epidermoid Cysts
Seborrheic Keratosis
Lentigo Simplex
Mole (Nevus)
Dermatofibroma
Neurofibroma
Capillary Hemangioma
Vitiligo
Suggested Readings
References
Chapter 60: Tuberculosis and Parasitic Infections of the Genitourinary Tract
Genitourinary Tuberculosis
History
Microbiology
Epidemiology
Infection, Host Immune Response, and Transmission
Development of Genitourinary Disease
Clinical Manifestations and Pathologic Features
Kidney
Ureter
Bladder
Epididymis, Vas Deferens, Testes, and Scrotum
Prostate and Seminal Vesicles
Urethra and Penis
Diagnosis
Culture
Nucleic Acid Amplification Tests
Histopathology
Screening Tests
Tuberculin Skin Test, Purified Protein Derivative, Mantoux Test.
Interferon-Gamma Release Assays.
Radiography
Plain Radiography.
Intravenous Urography.
Computed Tomography With Urography.
Retrograde Pyelography and Antegrade Pyelography.
Ultrasonography
Magnetic Resonance Imaging
Cystoscopy and Ureteroscopy
Treatment
Medical Therapy
Corticosteroids.
Surgical Therapy
Procedures to Relieve Obstruction.
Nephrectomy.
Ureteropelvic and Ureteral Surgery.
Endoscopic Management.
Open Surgical Options.
Bladder Surgery.
Urethral Procedures.
Genital Surgery.
Monitoring for Tuberculosis Relapse
Management of Genitourinary Tuberculosis in Special Situations
Multidrug-Resistant and Extensively Drug-Resistant Tuberculosis
Pregnancy and Lactation
Human Immunodeficiency Virus Infection
Renal Transplant Recipients
Parasitic Infections of the Urogenital Tract
Schistosomiasis
History
Biology and Life Cycle
Epidemiology
Pathogenesis and Pathology
Clinical Manifestations
Acute Schistosomiasis.
Chronic Schistosomiasis.
Diagnosis
Treatment
Medical Management.
Surgical Management.
Prognosis.
Prevention and Control
Filariasis
Organisms
Epidemiology
Pathology and Clinical Manifestations
Subclinical Infection.
Acute Adenolymphangitis.
Lymphedema.
Genitourinary Manifestations.
Funiculoepididymitis.
Hydroceles.
Scrotal and Penile Elephantiasis.
Chyluria.
Tropical Pulmonary Eosinophilia.
Diagnosis
Treatment
Prevention and Control
Other Nonfilarial Genitourinary Parasites
Echinococcosis
Enterobiasis
Amebiasis
Trichomoniasis
Suggested Readings
References
Part V: Molecular and Cellular Biology
Chapter 61: Basic Principles of Immunology and Immunotherapy in Urologic Oncology
Innate Immune System
Cytokines and Chemokines
Adaptive Immune System
Immune Editing Hypothesis
Chronic Inflammation and the Endogenous Immune Response to Genitourinary Cancers
Chronic Inflammation and the Immune Response to Bladder Cancer
Immune Microenvironment in Kidney Cancer
Chronic Inflammation and the Immune Response to Prostate Cancer
Immunotherapy for Genitourinary Cancers
Bacille Calmette-Guérin in Bladder Cancer
Cancer Vaccines
Vaccines for Kidney Cancer
Vaccines for Prostate Cancer
PD-1/PD-L1 Blockade in Genitourinary Cancers
PD-1/PD-L1 Blockade in Second-Line Bladder Cancer
PD-1/PD-L1 Blockade in First-Line Bladder Cancer
Selecting Bladder Cancer Patients for PD-1/PD-L1–Based Immunotherapy
PD-1/PD-L1 Blockade in Kidney Cancer
PD-1/PD-L1 Blockade in Prostate Cancer
Combination Immunotherapy Regimens in Genitourinary Cancers
CTLA-4 Blockade in Prostate and Kidney Cancer
Combining PD-1/PD-L1 Blockade With Androgen Deprivation Therapy in Prostate Cancer
Combining PD-1/PD-L1 Blockade With Chemotherapy in Bladder Cancer
Combining PD-1/PD-L1 Blockade With VEGF Inhibition in Kidney Cancer
Conclusions
Suggested Readings
References
Chapter 62: Molecular Genetics and Cancer Biology
Tumor Suppressor Genes and Oncogenes
Basic Molecular Genetics
DNA
Transcription.
Protein Synthesis.
Chromosomes and Gene Structure.
Tumor Suppressor Genes
Oncogenes
Cell Cycle Deregulation
Cyclin-Dependent Kinases and Cyclins
Cell Cycle Entry
Retinoblastoma Protein and the Restriction Point
Cell Cycle Progression Through S Phase
Mitosis
G1/S Checkpoint
S-Phase Arrest
G2/M Checkpoint
Mitotic Arrest: The Spindle Assembly Checkpoint
Retinoblastoma Protein and Genitourinary Malignancies
Cyclin-Dependent Kinase Inhibitors
TP53 Tumor Suppressor
DNA Methylation
DNA Methylation and Prostate Cancer
Role of DNA Methylation in Bladder Cancer
INK4A (p16) Methylation in Bladder Cancer
Hypermethylation of Other Genes in Bladder Cancer
Hypomethylation in Bladder Cancer
DNA Damage and Repair
DNA Repair Mechanisms
Double-Strand Break Repair
Genomic Alterations
Specific Chromosomal Rearrangements in Genitourinary Malignancies
Recurrent Gene Rearrangements in Prostate Cancer
Recurrent Gene Rearrangements in Renal Cancer
Recurrent Gene Rearrangements in Testicular Cancer
Other Genomic Alterations in Genitourinary Malignancies
Hereditary Prostate Cancer
Sporadic Prostate Cancer
Renal Cancer
Bladder Cancer
Intrinsic Subtypes of High-Grade Bladder Cancer
Genetic Alterations in Bladder Pre-Neoplasia
Genetic Alterations in Normal and Benign Bladder Urothelium
Molecular Genetic-Based Assays for Bladder Cancer Detection and Surveillance
Testicular Cancer
Telomeres and Telomerase
Telomeres and Chromosomal Instability
Telomere Shortening Acts as a Tumor Suppressive Mechanism in Normal Cells
Cancers and Premalignant Lesions Possess Abnormally Short Telomeres
Telomerase Activity Restabilizing Chromosomes and Allowing Unlimited Cellular Replication
Telomerase Activity as a Potential Diagnostic Marker
Potential Prognostic Value of Telomere Length in Prostate Cancer
Telomerase-Based Opportunities for Therapy
Apoptosis
Apoptosis and Cancer
Apoptosis, an Evolutionarily Conserved Process
Intrinsic Apoptotic Pathway
Extrinsic Apoptotic Pathway
Role of TP53 in Apoptosis
Apoptosis and Genitourinary Malignancies
Global Defects in Apoptosis
Alternative Regulators of Apoptosis in Genitourinary Malignancies
Stem Cells and Cancer
Checkpoint Inhibition
Microbiome and Cancer: the Metagenome
Suggested Readings
References
Part VI: Reproductive and Sexual Function
Chapter 63: Surgical, Radiographic, and Endoscopic Anatomy of the Male Reproductive System
Testis
Gross Structure
Microanatomic Architecture
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Blood-Testis Barrier
Ultrasonography
Magnetic Resonance Imaging
Epididymis
Gross Structure
Microanatomic Architecture
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Ultrasonography
Magnetic Resonance Imaging
Vas Deferens
Gross Structure
Microanatomic Architecture
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Vasogram
Seminal Vesicles and Ejaculatory Ducts
Gross Structure
Microanatomic Architecture
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Transrectal Ultrasonography
Computed Tomography
Magnetic Resonance Imaging
Prostate
Gross Structure
Microanatomic Architecture
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Transrectal Ultrasonography of the Prostate
Magnetic Resonance Imaging of the Prostate
Urethra
Prostatic Urethra
Membranous Urethra
Penile Urethra
Fossa Navicularis
Penis
Structure
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Cavernosogram
Doppler Ultrasound of the Penis
Magnetic Resonance Imaging
Scrotum
Gross Structure
Arterial Supply
Venous Drainage
Lymphatic Drainage
Nerve Supply
Suggested Readings
References
Chapter 64: Male Reproductive Physiology
Hypothalamic-Pituitary-Gonadal Axis
Basic Endocrine Concepts
Components of the Reproductive Axis
Hypothalamus
Anterior Pituitary
Testis
Development of the Hypothalamic-Pituitary-Gonadal Axis
Aging and the Hypothalamic-Pituitary-Gonadal Axis
Testis
Gross Architecture
Testis Cytoarchitecture
Interstitium
Leydig Cells.
Testosterone.
Control of Testosterone Synthesis.
Testosterone Cycles.
Seminiferous Tubules
Sertoli Cells.
Germ Cells.
Peritubular Structure
Blood-Testis Barrier
Spermatogenesis
Testis Stem Cell Migration, Renewal, and Proliferation
Testis Stem Cell Migration.
Testis Stem Cell Renewal.
Testis Stem Cell Proliferation.
Meiosis
Spermiogenesis
Sertoli Cell–Germ Cell Interaction
Genetics
Genetics and Paternal Age
Age-Related Sperm Chromosomal Anomalies.
Age-Related Sperm Genetic Mutations.
Age-Related Sperm Epigenetic Changes.
Epididymis
Gross Architecture
Vascular and Lymph Supply
Innervation
Cytoarchitecture
Epididymal Epithelium
Epididymal Contractile Tissue.
Epididymal Function
Sperm Transport
Sperm Storage
Sperm Maturation
Sperm Motility.
Sperm Fertility.
Sperm Biochemical Changes.
Regulation of Epididymal Function
Ductus (Vas) Deferens
Gross Architecture
Cytoarchitecture
Vas Deferens Function
Sperm Transport
Absorption and Secretion
Seminal Vesicle and Ejaculatory Ducts
Gross Architecture and Cytoarchitecture
Seminal Vesicle
Ejaculatory Ducts
Seminal Vesicle and Ejaculatory Duct–Unit Function
Seminal Vesicle Function
Spermatozoa
Anatomy and Physiology
Summary
Suggested Readings
References
Chapter 65: Integrated Men’s Health: Androgen Deficiency, Cardiovascular Risk, and Metabolic Syndrome
Rationale for Integrative Men’s Health
Introduction to the Problem
Gender Longevity Gap
Health and Wellness Gap by Gender
Explanation of the Poorer Health of Men
Propensity for Risk-Taking Behavior
Masculinity Defined Norms of Behavior and Attitudes Toward Health
Physical and Chemical Exposure in the Workplace
Targets and Effective Interventions
Global Men’s Health Movement
Metabolic Syndrome and Men’s Health
Introduction, History, and Definitions
Prevalence and Predictors of Metabolic Syndrome
Physiology of Metabolic Syndrome
Abdominal Obesity
Insulin Resistance
Dyslipidemia
Hypertension
Genetics
Endothelial Dysfunction
Hypercoagulable State
Dietary Factors
Glucocorticoid and Stress-Response Mediators
Obstructive Sleep Apnea
Metabolic Syndrome and Urologic Disorders
Renal Conditions
Renal Insufficiency.
Stones.
Tumors.
Bladder Cancers
Overactive Bladder
Lower Urinary Tract Symptoms
Prostate Cancer
Low Testosterone and Erectile Dysfunction
Targeting Metabolic Syndrome as a Novel Strategy in Disease Etiology
Diet and Exercise
Statins
Metformin
Testosterone Therapy
Metabolic Syndrome in Integrative Men’s Health
Conclusion
Testosterone Therapy and Cardiovascular Risk: Advances and Controversies
Introduction and Historical Context
Clinical Trials: Evidence of Effectiveness
Cardiovascular Risk
What Is a Clinician to Do?
Association Between Cardiovascular Disease and Erectile Dysfunction
Predisposing Factors
Erectile Dysfunction and Subclinical Cardiovascular Disease
Mental Health and Opioid Abuse in Men
Mental Illness in Men
Consequences of Opioid Abuse
Opioid Prescriptions
Gonadal Dysfunction
Role of Urology
Building an Integrative Men’s Health Center
Components
Curriculum
Future Business Plan
References
Chapter 66: Male Infertility
Epidemiology
History
Spermatotoxicity
Endocrine Modulators
Recreational Drugs
Antihypertensives
Antipsychotics
Opioids
Antibiotics
Cytotoxic Chemotherapeutics
Anti-Inflammatory Agents
Phosphodiesterase V Inhibitors
Environmental Toxicants
Thermal Toxicity
Radiation
Infections and Inflammation
Childhood Diseases
Pediatric Surgery
Testis Torsion
Cryptorchidism
Testicular Dysgenesis Hypothesis
Genetics
Sexual History
Physical Examination
General Physical Examination
Male Reproductive Physical Examination
Examining the Scrotum
Examining the Testis and Epididymis
Examining the Spermatic Cord
Examining the Phallus
Examining the Prostate and Seminal Vesicles
Laboratory Evaluation of Male Infertility
Endocrine Evaluation
Evaluation of Semen
Bulk Semen Parameters and the World Health Organization Criteria
Semen Volume.
Sperm Density.
Sperm Motility.
Sperm Morphology.
Sperm Vitality.
Computer-Assisted Semen Analysis.
Secondary Semen Assays
Pyospermia Assays.
Tertiary and Investigational Sperm Assays
Sperm DNA Integrity Assays.
TUNEL Assay.
Comet Assay.
Denatured Sperm DNA Assays.
Reactive Oxygen Species.
Acrosome Reaction.
Sperm Mucus Interaction.
Sperm Ovum Interaction.
Sperm Ultrastructural Assessment.
Sperm Fluorescence in situ Hybridization.
Genomic Assessment
Karyotype
Y Chromosome Microdeletion Testing
Genomic Sequence Assessment
Cystic Fibrosis Transmembrane Conductance Regulator Mutation Assessment
Imaging in the Evaluation of Male Infertility
Scrotal Ultrasonography
Vasography
Venography
Transrectal Imaging
Abdominal Imaging
Cranial Imaging
Testis Histopathology
Assisted Reproduction
Intrauterine Insemination
In vitro Fertilization
Diagnoses and Therapies
Genetic Syndromes
Chromosomal Numerical Disorders
Structural Chromosomal Anomalies
Epigenetic Anomalies
Testicular Causes
Spermatogenic Dysfunction
Steroidogenic Dysfunction
Microductal Obstruction
Pituitary Dysfunction
Hypogonadotropic Hypogonadism
Pituitary Tumors and Diseases
Other Pituitary Lesions
Extrapituitary Endocrine Modulators
Extratesticular Endocrine Dysfunction
Developmental Disorders
Intersex or Disorders of Sexual Development
Hypospadias and Epispadias
Cryptorchidism
Microductal Aplasia
Congenital Unilateral Absence of the Vas Deferens.
Congenital Bilateral Absence of the Vas Deferens.
Varicocele
Ejaculatory Dysfunction
Ejaculatory Ductal Obstruction
Retrograde Ejaculation
Anejaculation
Structural Sperm Abnormalities
Empirical Treatment
Fertility Preservation in Cancer
Sperm Cryopreservation
Testicular Tissue Cryopreservation
Prepubescent Considerations
Future Perspectives
Suggested Readings
References
Chapter 67: Surgical Management of Male Infertility
Surgical Anatomy
Testicular Blood Supply
Epididymal Blood Supply
Blood Supply of the Vas Deferens
Anatomy of the Excurrent Ducts
Ejaculatory Ducts
Testis Biopsy
Indications
Open Testis Biopsy: Microsurgical Technique
Percutaneous Testis Biopsy
Percutaneous Testicular Aspiration
Complications of Testis Biopsy
Vasography
Indications
Technique of Vasography and Interpretation of Findings
Complications of Vasography
Stricture
Injury to the Vasal Blood Supply
Hematoma
Sperm Granuloma
Transrectal Vasography and Seminal Vesiculography
Summary
Vasovasostomy
Preoperative Evaluation
Physical Examination
Laboratory Tests
Anesthesia
Surgical Approaches: Scrotal
Surgical Approaches: Inguinal
Preparation of the Vasa
When to Perform Vasoepididymostomy
Multiple Vasal Obstructions
Varicocelectomy and Vasovasostomy
Anastomotic Techniques: Keys to Success
Setup
Microsurgical Multilayer Microdot Method
Anastomosis in the Convoluted Vas
Crossed Vasovasostomy
Technique
Transposition of the Testis
Wound Closure
Postoperative Management
Postoperative Complications
Long-Term Follow-Up Evaluation After Vasovasostomy
Surgery of the Epididymis
Vasoepididymostomy
Indications
Microsurgical End-to-Side Vasoepididymostomy
Intussusception Vasoepididymostomy
Technique When Vasal Length Is Severely Compromised
Varicocelectomy and Vasoepididymostomy
Long-Term Follow-Up Evaluation and Results
Transurethral Resection of the Ejaculatory Ducts
Diagnosis
Technique
Complications
Reflux
Epididymitis
Retrograde Ejaculation
Results
Electroejaculation
Indications
Anesthesia
Technique
Sperm Retrieval Techniques
Microsurgical Epididymal Sperm Aspiration Techniques
Open Tubule Technique
Percutaneous Epididymal Sperm Aspiration
Testicular Sperm Extraction
Microsurgical Testicular Sperm Extraction
Technique.
Results.
Postmortem Sperm Retrieval
Varicocelectomy
Scrotal Operations
Retroperitoneal Operations
Laparoscopic Varicocelectomy
Microsurgical Inguinal and Subinguinal Operations: the Preferred Approaches
Anesthesia
Inguinal and Subinguinal Approaches
Dissection of the Cord
Delivery of the Testis
Radiographic Occlusion Techniques
Complications of Varicocelectomy
Hydrocele
Testicular Artery Injury
Varicocele Recurrence
Results
Summary
Orchiopexy in Adults
Retractile or Ectopic Testes in Adults
Acknowledgments
References
Chapter 68: Physiology of Penile Erection and Pathophysiology of Erectile Dysfunction
Physiology of Penile Erection
Historical Contexts on Our Understanding of Erectile Physiology
Functional Anatomy of the Penis
Corpora Cavernosa, Corpus Spongiosum, and Glans Penis
Tunica Albuginea
Arteries
Veins
Hemodynamics and Mechanism of Erection and Detumescence
Corpora Cavernosa
Corpus Spongiosum and Glans Penis
Neuroanatomy and Neurophysiology of Penile Erection
Spinal Centers and Peripheral Pathways
Autonomic Pathways.
Somatic Pathways.
Supraspinal Pathways and Centers
Neurotransmitters
Peripheral Neurotransmitters and Endothelium-Derived Factors Facilitating Penile Erection.
Peripheral Neurotransmitters and Endothelium-Derived Factors Opposing Penile Erection.
Interactions Among Nerves and Neurotransmitters.
Molecules That Modulate Penile Erection via the Central Nervous System.
Dopamine.
Oxytocin.
Nitric Oxide.
Serotonin.
Norepinephrine.
Melanocortins.
Prolactin.
γ-Aminobutyric Acid.
Opioids.
Cannabinoids.
Smooth Muscle Physiology
Cytosolic Calcium and the Calcium Sensitization Pathway
Cytosolic Free Calcium.
Rho Kinase Signaling Pathway.
Molecular Pathways That Directly Modulate Intracellular Free Calcium
Molecular Pathways That Indirectly Modulate Intracellular Free Calcium
Modulation of Antitumescence Pathways By Protumescence Pathways
Cyclic Guanosine Monophosphate–Signaling Pathway
Nitric Oxide.
Carbon Monoxide.
Hydrogen Sulfide.
Natriuretic Peptides.
Guanylyl Cyclase Pathway.
Protein Kinase G.
Adenylyl Cyclase Pathway.
Protein Kinase A.
Phosphodiesterase.
Caveolae.
Ion Channels.
Additional Cyclic Adenosine Monophosphate– Signaling Pathways
Adenosine.
Calcitonin Gene–Related Peptide Family.
Prostaglandins.
Vasoactive Intestinal Peptide.
Molecular Oxygen as a Modulator of Penile Erection.
Intercellular Communication.
Intracavernous Tissue Architecture and Erectile Response
Pathophysiology of Erectile Dysfunction
Incidence and Epidemiology
Risk Factors
Psychogenic
Neurogenic
Endocrinologic
Arteriogenic
Cardiovascular Diseases.
Hyperlipidemia.
Obesity.
Hypertension.
Mechanism of Vascular Erectile Dysfunction
Arteriogenic ED.
Enhanced Smooth Muscle Contraction and Vasoconstriction.
Impaired Endothelium-Dependent Smooth Muscle Relaxation.
Corporal Structural Defects
Sonic Hedgehog Protein.
Endothelium.
Drug-Induced
Antihypertensive Agents.
Diuretics.
β-Adrenergic Blockers.
α-Adrenoceptor Blockers.
Angiotensin-Converting Enzyme Inhibitors.
Angiotensin II Type 1 Receptor Antagonists.
Calcium Channel Blockers.
Aldosterone Receptor Antagonists.
Summary on Antihypertensives.
Psychotropic Medication.
Antipsychotics.
Antidepressants.
Other Antidepressants.
Anxiolytics.
Anticonvulsants.
Antiandrogens.
Miscellaneous Drugs.
Digoxin.
Statins.
Histamine H2 Receptor Antagonists.
Opiates.
Antiretroviral Agents.
Tobacco.
Alcohol.
Aging, Systemic Disease, and Other Causes
Diabetes Mellitus.
Metabolic Syndrome.
Chronic Renal Failure.
Hyperuricemia.
Other Chronic Medical Conditions.
Primary Erectile Dysfunction
Micropenis.
Vascular Abnormalities.
Perspectives
Suggested Readings
References
Chapter 69: Evaluation and Management of Erectile Dysfunction
Historical Perspective
Public Health Significance
Epidemiology
Health Policy
Management Principles
Early Detection
Shared Decision Making and Treatment Planning
Step-Care Approach
Role of Partner Interview
Cardiac Risk Assessment
Specialist Referral
Follow-Up Care
Diagnostic Evaluation
Sexual, Medical, and Psychosocial History
Sexual History
Medical History
Psychosocial History
Physical Examination
Questionnaires and Sexual Function Symptom Scores
Cardiovascular Risk Assessment Tools
Laboratory Tests
Specialized Evaluation and Testing
Vascular Evaluation
Combined Intracavernosal Injection and Stimulation
Duplex Ultrasonography (Gray Scale or Color-Coded)
Dynamic Infusion Cavernosometry and Cavernosography
Penile Angiography
Historical and Investigational Studies of Penile Blood Flow
Penile Brachial Pressure Index
Penile Plethysmography (Penile Pulse Volume Recording)
Radioisotopic Penography
Penile Magnetic Resonance Imaging
Penile Near Infrared Spectrophotometry
Cavernous Smooth Muscle Content
Psychophysiologic Evaluation
Penile Tumescence and Rigidity Monitoring
Audiovisual and Vibratory Stimulation
Neuroimaging
Psychological Evaluation
Neurologic Evaluation
Somatic Nervous System
Biothesiometry.
Sacral Evoked Response: Bulbocavernosus Reflex Latency.
Dorsal Nerve Conduction Velocity.
Genitocerebral Evoked Potential.
Autonomic Nervous System
Heart Rate Variability and Sympathetic Skin Response.
Penile Thermal Sensory Testing.
Electrochemical Skin Conductance Testing.
Corpus Cavernosum Electromyography and Single Potential Analysis of Cavernous Electrical Activity.
Hormonal Evaluation
Serum Testosterone Measurements
Serum Gonadotropin Measurements
Serum Prolactin Measurement
Magnetic Resonance Imaging Scans
Serum Thyroid Function Tests
Treatment Considerations
Lifestyle Modification
Medication Change
Psychosexual Therapy
Hormonal Therapy
Testosterone Therapy
Intramuscular.
Subcutaneous.
Transdermal.
Buccal.
Oral.
Alternative Hormone Treatments
Hyperprolactinemia Treatments
Pharmacologic Therapies
Oral Therapy
Phosphodiesterase Type 5 Inhibitors.
α-Adrenoceptor Antagonists.
Dopaminergic Agonists.
Melanocortin-Receptor Agonists.
Serotonin-Receptor Effectors.
Other Oral Therapies.
Intracavernosal Injection
Alprostadil.
Papaverine.
Phentolamine.
Vasoactive Intestinal Polypeptide.
Intraurethral Suppositories
Transdermal/Topical Pharmacotherapy
Medical Device
Surgery
Penile Prosthesis Surgery
Penile Revascularization Surgery
Arterial Revascularization.
Venous Reconstruction.
Combination Therapies
Alternative Therapies
Future Directions
Acknowledgment
References
Chapter 70: Priapism
Defining Priapism
Classifying Priapism
Ischemic Priapism (Veno-occlusive, Low-Flow)
Stuttering Priapism (Intermittent, Recurrent Ischemic Priapism)
Nonischemic Priapism (Arterial, High Flow)
Priapism: Historical Perspectives
Epidemiology of Priapism
Etiology of Ischemic Priapism (Veno-occlusive, Low-Flow)
Sickle Cell Disease
Iatrogenic Priapism: Intracavernous Injections
Iatrogenic Priapism: Oral Phosphodiesterase Type 5 Inhibitors, Medications for Attention-Deficit/Hyperactivity Disorder, and Nutritional Supplements for Erectile Dysfunctions
Etiology of Stuttering Priapism (Recurrent Ischemic Priapism)
Etiology and Pathophysiology of Nonischemic (Arterial, High-Flow) Priapism
Priapism in Children
Molecular Basis of Ischemic and Stuttering Priapism
Evaluation and Diagnosis of Priapism
History
Physical Examination
Laboratory Testing
Penile Imaging
Medical Treatments
Ischemic Priapism
Stuttering Priapism
Hormonal Therapies
Baclofen
Phosphodiesterase Type 5 Inhibitors in the Management of Stuttering Priapism: A Counterintuitive Treatment Strategy
Surgical Management of Ischemic Priapism
Shunting
Immediate Implantation of Penile Prosthesis
Interventional Angiography in the Management of Arterial (Nonischemic, High-Flow) Priapism
Surgical Management of Arterial (Nonischemic, High-Flow) Priapism
Summary
Suggested Readings
References
Chapter 71: Disorders of Male Orgasm and Ejaculation
Anatomy and Physiology of the Ejaculatory Response
Premature Ejaculation
Classification of Premature Ejaculation
Definition of Premature Ejaculation
Traditional Definitions of Premature Ejaculation
International Society for Sexual Medicine Definition of Premature Ejaculation
Rationale for ISSM Definition of Lifelong and Acquired Premature Ejaculation.
Rationale for Inclusion of “The Inability to Delay Ejaculation on All or Nearly All Vaginal Penetrations.”
Rationale for Inclusion of “Negative Personal Consequences, Such as Distress, Bother, Frustration, and/or the Avoidance of Sexual Intimacy.”
Rationale for Exclusion of Sexual Satisfaction.
Diagnostic and Statistical Manual of Mental Disorders Definition of Premature Ejaculation
Prevalence of Premature Ejaculation
Cause of Premature Ejaculation
Lifelong Premature Ejaculation
Acquired Premature Ejaculation
Premature Ejaculation and Sexual Performance Anxiety, and Psychological or Relationship Problems
Premature Ejaculation and Comorbid Erectile Dysfunction
Premature Ejaculation and Prostate Disease
Premature Ejaculation and Hyperthyroidism
Evaluation of Men Complaining of Premature Ejaculation
Medical History
Diagnosis of Premature Ejaculation
Determination of Intravaginal Ejaculation Latency Time
Patient Reported Outcome Measures
Premature Ejaculation Profile
Index of Premature Ejaculation
Premature Ejaculation Diagnostic Tool
Assessment of Erectile Function
Physical Examination
Treatment of Premature Ejaculation
Psychosexual Therapy
Pharmacologic Treatment
Treatment With Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants.
Dapoxetine.
Off-Label Selective Serotonin Reuptake Inhibitors and Tricyclic Antidepressants.
Topical Local Anesthetics.
PDE5 Inhibitors.
On-Demand Treatment With Off-Label Tramadol.
Daily Treatment With Off-Label α1-Adrenoceptor Antagonists.
Intracavernosal Injection of Off-Label Vasoactive Drugs.
Emerging Investigational Drugs
DA-8031.
Oxytocin Antagonists.
Modafinil.
Botulinum-A Toxin.
Acupuncture
Surgical Neurotomy, Cryoablation, and Neuromodulation of the Dorsal Penile Nerve
Kate! Delayed Ejaculation, Anejaculation, and Anorgasmia
Definition, Terminology, and Characteristics of Men With Delayed Ejaculation
Terminology and Definition
Epidemiology of Delayed Ejaculation
Cause of Delayed Ejaculation/Anejaculation
Psychological Delayed Ejaculation
Congenital Disorders
Infective Disorders
Ejaculatory Duct Obstruction
Endocrinopathy
Iatrogenic Causes
Treatment of Male Pelvic Cancers
Prostate Cancer
Rectal Carcinoma
Testicular Cancer
Neurologic Disorders
Spinal Cord Injury
Evaluation of Men With Delayed Ejaculation
Treatment of Men With Delayed Ejaculation/Anejaculation
Psychological Strategies in the Treatment of Delayed Ejaculation
Pharmacotherapy in the Treatment of Delayed Ejaculation
Retrograde Ejaculation
Treatment
Sperm Retrieval in Men With Anejaculation Pursuing Fertility
Ejaculatory Anhedonia
Post-SSRI Sexual Dysfunction
Orgasmic Headache
Painful Ejaculation
Postorgasmic Illness Syndrome
Conclusion
Suggested Readings
References
Chapter 72: Surgery for Erectile Dysfunction
Types of Implants Available
Informed Consent
Preoperative Preparation
Incisions
Technique of Device Placement
Reservoir Placement
Intraoperative Troubleshooting
Fibrotic Corpora
Crural Crossover
Corporal Perforation
Hypermobile Glans Penis
Curved Erection After Cylinder Placement
Postoperative Complications
Implant Infection
Cylinder Aneurysm
Cylinder Extrusion
Cylinder Erosion
Visceral Erosion of the Reservoir
Penile Necrosis After Implant Placement
Special Situations
Immunosuppressed Patients
Penile Implants in Ischemic Priapism
Lax Suspensory Ligament
Long-Distance Bicycle Riding
Postoperative Care
Mechanical Reliability: Repair for Mechanical Defect
Patient and Partner Satisfaction
Suggested Readings
References
Chapter 73: Diagnosis and Management of Peyronie’s Disease
General Considerations
Natural History
Epidemiology
Incidence
Associated Conditions
Aging
Diabetes
Erectile Dysfunction
Psychological Aspects
Radical Prostatectomy
Hypogonadism
Collagen Disorders
Penile Anatomy and Peyronie’s Disease
Impact of Wound Healing on the Development of Peyronie’s Disease
Etiology of Peyronie’s Disease
Role of Oxygen Free Radicals and Oxidative Stress
Role of Nitric Oxide in Peyronie’s Disease
Role of Myofibroblasts in Peyronie’s Disease
Role of Transforming Growth Factor-β1 in the Etiology of Peyronie’s Disease
Fibrotic Gene Expression in Peyronie’s Disease
Symptoms
Evaluation of the Patient
Treatment Protocols
Nonsurgical Treatment of Peyronie’s Disease
Oral Medications
Potaba
Vitamin E
Tamoxifen
Colchicine
Carnitine
Pentoxifylline
Phosphodiesterase Type 5 Inhibitors
Intralesional Injection
Verapamil
Nicardipine
Interferon Alfa-2b
Collagenase Clostridium Histolyticum
Topical Drug Application
Electromotive Drug Administration
Extracorporeal Shock Wave Therapy
Penile Traction
Vacuum Therapy
Combination Therapy
Radiation Therapy
Conclusion
Surgical Management
Indications
Tunical Shortening Procedures
Tunical Lengthening Procedures (Plaque Incision or Partial Excision and Grafting)
Graft Materials
Grafting Surgical Technique
Postoperative Management
Penile Prosthesis for Men With Peyronie’s Disease
Indications
Techniques for Straightening When Placing a Penile Prosthesis for Peyronie’s Disease
Conclusion
Suggested Readings
References
Chapter 74: Sexual Function and Dysfunction in the Female
Anatomy and Physiology of Female Sexual Organs
Vulva
Mons Pubis
Clitoris
Labia
Vestibule
Introitus
Hymen Vaginae
Fourchette
Perineal Body
Female Urethra and Urethral Orifice
Vulva: Vascularization, Lymphatic Drainage, and Neuroanatomy
The Clitoral Complex
Clitoral Complex: Vascularization and Neuroanatomy
Female Sexual Physiology
Female Sexual Response
Neurogenic Mediators of the Female Sexual Response
Hormonal Regulators of Female Sexual Response
Estrogens
Testosterone
Mental Aspects of Sexual Response
Evaluation of Sexual Wellness
History Taking
The PLISSIT Model of Assessment and Treatment
Questionnaires
Evaluation of the Partner
Physical Examination
Laboratory Tests
Physiologic Measures of Sexual Function
Definitions of Sexual Dysfunctions in Female Patients
DSM-5 Definitions of Sexual Dysfunctions in Women
Female Sexual Interest–Arousal Disorder
Female Orgasmic Disorder
Genito-Pelvic Pain-Penetration Disorder
International Consultation on Sexual Medicine Definitions of Sexual Dysfunctions in Women
Hypoactive Sexual Desire Dysfunction
Female Sexual Arousal Dysfunction
Female Orgasmic Dysfunction
Female Genital-Pelvic Pain Dysfunction
Persistent Genital Arousal Disorder
Postcoital Syndrome (Postorgasmic Illness Syndrome)
Hypohedonic Orgasm
Painful Orgasm
Epidemiology of Female Sexual Dysfunction
Interest and Desire
Arousal
Orgasm
Dyspareunia and Vaginismus
Special Populations
LGBTQ
Gender Dysphoria and Hormonal Treatment
Fertility in Transgender People
Malignancies in Female Transgender Patients
Sexuality and Disability
Female Sexual Interest Disorder
Definition
Pathophysiology
Evaluation
Treatment
Psychological Treatment
Medical Treatment
Hormones
Bupropion
Buspirone
Flibanserin
Others
Female Orgasmic Disorder
Assessment
Psychosocial Treatment
Education
Directed Masturbation and Sensate Focus
Mindfulness and Yoga
Coital Alignment Technique
Sexual Enhancement Products
Medical Treatment
Women With Female Orgasmic Disorder Together With Desire and Arousal Problems
Phosphodiesterase Type 5 Inhibitors
Hormones
Women With Female Orgasmic Disorder Who Report Subjectively Sufficient Arousal
Oxytocin
Medication-Induced Female Orgasmic Disorder
Female Sexual Arousal Disorder
Interview Assessment of Sexual Arousal
Potential Treatments for the Psychosocial Aspects of Female Sexual Arousal Disorder
Pharmacotherapy for Female Sexual Arousal Disorder
Hormonal Therapy
Testosterone and Selective Tissue Estrogenic Activity Regulator
Nonhormonal Therapy
Phosphodiesterase Type 5 Inhibitors
Prostaglandins
l-Arginine
Dopamine Agonists
Bupropion
Oxytocin
Female Persistent Genital Arousal Disorder
Psychosocial Characterization and Etiologic Factors
Treatment Targets
Genitopelvic Pain and Penetration Disorder
Pain and Sex
Provoked Vestibulodynia
Primary
Secondary
Pathogenesis
Clitoris and Clitorodynia
Clinical Presentation (Fig. 74.10)
Menopause and Dyspareunia
Previous Genitourinary Surgery
Treatment
Education
Biofeedback
Dilators and Insertion Techniques
Electrical Stimulation
Manual Therapy
Multimodal Physical Therapy
Topical Therapy
Surgery
Multidisciplinary and Multimodality Approaches
Lower Urinary Tract Dysfunction and Female Sexual Dysfunction
Sexual Lifestyle and Communication
Epidemiology
Etiology and Classification
Clinical Signs and Investigations
Lower Urinary Tract Symptoms and Female Sexual Dysfunction: Links and Treatments
Urinary Incontinence and Overactive Bladder
Pelvic Organ Prolapse
Bladder Pain Syndrome/Interstitial Cystitis
Self-Image/Body Image Connected to Female Sexual Dysfunction and Lower Urinary Tract Symptoms
Conclusion
References
Part VII: Male Genitalia
Chapter 75: Surgical, Radiographic, and Endoscopic Anatomy of the Retroperitoneum
Body Surface Landmarks
Posterior Abdominal Wall
Flank Muscles (Figs. 75.4 to 75.7 and Table 75.2)
Psoas, Iliacus, Quadratus Lumborum, and Erector Spinae (Fig. 75.8; also see Figs. 75.4 to 75.7 and Table 75.2)
Spine
10th, 11th, and 12th Ribs
Lumbodorsal Fascia
Retroperitoneal Fasciae and Spaces
Transversalis Fascia and Posterior Pararenal Space
Gerota Fascia (Renal Fascia) and Perirenal Space
Anterior Pararenal Space and Inner Stratum
Gastrointestinal Viscera and Mesentery
Vasculature
Arterial System
Venous System
Lymphatic System
Nervous Structures
Autonomic Nervous System
Somatic Nervous System
Suggested Readings
References
Chapter 76: Neoplasms of the Testis
Germ Cell Tumors
Epidemiology
Risk Factors
Pathogenesis and Biology
Histologic Classification
Germ Cell Tumor Neoplasia in Situ
Seminoma
Spermatocytic Tumor
Embryonal Carcinoma
Choriocarcinoma
Yolk Sac Tumor
Teratoma
Initial Presentation
Signs and Symptoms
Physical Examination
Differential Diagnosis
Diagnostic Delay
Diagnostic Testing and Initial Management
Scrotal Ultrasound
Magnetic Resonance Imaging
Serum Tumor Markers
Radical Inguinal Orchiectomy
Testis-Sparing Surgery
Contralateral Testis Biopsy
Suspected Extragonadal Germ Cell Tumor
Clinical Staging
Staging Imaging Studies
Clinical Staging of the Abdomen and Pelvis
Pathological Staging of the Abdomen and Pelvis
Chest Imaging
Serum Tumor Markers
Prognostic Classification of Advanced Germ Cell Tumor
Sperm Cryopreservation
Treatment
Therapeutic Principles
Contrasting Seminoma and Nonseminoma Germ Cell Tumor
Germ Cell Neoplasia in Situ
Nonseminoma Germ Cell Tumor
Clinical Stage I Nonseminoma Germ Cell Tumor
Risk Assessment.
Surveillance.
Retroperitoneal Lymph Node Dissection.
Primary Chemotherapy.
Treatment Selection for Clinical Stage I Nonseminoma Germ Cell Tumor.
Clinical Stage IS Nonseminoma Germ Cell Tumor
Clinical Stage IIA and IIB Nonseminoma Germ Cell Tumor
Clinical Stage IIC and III Nonseminoma Germ Cell Tumor
Chemotherapy for Good-Risk Nonseminoma Germ Cell Tumor.
Chemotherapy for Intermediate- and Poor-Risk Nonseminoma Germ Cell Tumor.
Management of Post-Chemotherapy Residual Masses in Nonseminoma Germ Cell Tumor.
Relapsed Nonseminoma Germ Cell Tumor
Chemotherapy-Naïve Nonseminoma Germ Cell Tumor Relapse.
Post-Chemotherapy Nonseminoma Germ Cell Tumor Relapse—Early.
Management of Post-Salvage Chemotherapy Residual Masses.
Desperation Surgery.
Post-Chemotherapy Nonseminoma Germ Cell Tumor Relapse—Late.
Seminoma
Clinical Stage I Seminoma
Primary Radiotherapy.
Surveillance.
Primary Chemotherapy With Single-Agent Carboplatin.
Clinical Stage IIA and IIB Seminoma
Clinical Stage IIC and III Seminoma
Management of Post-Chemotherapy Residual Masses.
Relapsed Seminoma
Chemotherapy-Naïve Seminoma Relapse.
Post-Chemotherapy Seminoma Relapse—Early.
Post-Chemotherapy Seminoma Relapse—Late.
Brain Metastases
Treatment Sequelae
Early Toxicity
Late Toxicity
Non–Germ Cell Tumors
Sex Cord-Stromal Tumors
Leydig Cell Tumors
Sertoli Cell Tumor
Granulosa Cell Tumors
Gonadoblastoma
Miscellaneous Testis Neoplasms
Dermoid and Epidermoid Cyst
Adenocarcinoma of the Rete Testis
Testicular “Tumor” of the Adrenogenital Syndrome.
Secondary Tumors of the Testis
Lymphoma
Leukemic Infiltration
Metastases
Tumors of the Testicular Adnexa
Adenomatoid Tumor
Cystadenoma
Mesothelioma
Sarcoma
Suggested Readings
References
Chapter 77: Surgery of Testicular Tumors
Management of Testis Mass
History and Physical Examination, Ultrasonography, and Preorchiectomy Evaluation
Radical Orchiectomy
Technique
Partial Orchiectomy
Technique
Delayed Orchiectomy
Postorchiectomy Evaluation
Retroperitoneal Lymph Node Dissection
Preoperative Planning
Surgical Technique
Exposure of the Retroperitoneum
Split and Roll Technique (Video 77.1)
Left Para-Aortic Packet
Interaortocaval Packet
Right Paracaval Packet
Gonadal Vein
Nerve Sparing
Closure and Postoperative Care
Auxiliary Procedures
Nephrectomy
Major Vascular Reconstruction
Inferior Vena Cava Resection
Aortic Reconstruction
Hepatic Resections
Pelvic Resections
Management of Supradiaphragmatic Disease
Resection of Retrocrural Disease
Surgical Decision Making
Management of Clinical Complete Remission to Induction Chemotherapy
Use of Modified Templates in Primary Retroperitoneal Lymph Node Dissection
Use of Modified Templates in Retroperitoneal Lymph Node Dissection After Chemotherapy
Adjuvant Chemotherapy for Pathologic Stage II Disease at Primary Retroperitoneal Lymph Node Dissection
Histologic Findings at Post-Chemotherapy Retroperitoneal Lymph Node Dissection and Survival Outcomes
Outcomes by Histology
Fibrosis/Necrosis
Teratoma
Viable Malignancy
Adjuvant Chemotherapy
Post-Chemotherapy Retroperitoneal Lymph Node Dissection in High-Risk Populations
Salvage Retroperitoneal Node Dissection
Desperation Retroperitoneal Node Dissection
Reoperative Retroperitoneal Node Dissection
Late Relapse
Surgical Outcomes, Functional Considerations, and Complications of Retroperitoneal Lymph Node Dissection
Lymph Node Counts
Retroperitoneal Lymph Node Dissection and Fertility
Fertility in Patients Undergoing Retroperitoneal Lymph Node Dissection
Ejaculatory Dysfunction and Retroperitoneal Lymph Node Dissection
Complications of Retroperitoneal Lymph Node Dissection
Pulmonary Complications
Ileus
Lymphocele
Chylous Ascites
Venous Thromboembolism
Neurologic Complications
Mortality
Retroperitoneal Lymph Node Dissection in Unique Situations
Post-Chemotherapy Retroperitoneal Node Dissection for Seminoma
Post-Chemotherapy Retroperitoneal Node Dissection for Sex Cord Stromal Tumors
Conclusion
References
Chapter 78: Laparoscopic and Robotic-Assisted Retroperitoneal Lymphadenectomy for Testicular Tumors
Rationale and Evolution
Staging Laparoscopic Retroperitoneal Lymph Node Dissection and Controversy
Duplication of Open Retroperitoneal Lymph Node Dissection
Development of Robotic-Assisted Retroperitoneal Lymph Node Dissection
Surgical Technique
Preoperative Patient Preparation and Technical Considerations
Laparoscopic Approach
Patient Positioning and Port Placement for Laparoscopic Retroperitoneal Lymph Node Dissection
Right-Sided Dissection
Spermatic Cord Dissection
Lymphadenectomy
Left-Sided Dissection
Spermatic Cord Dissection
Lymphadenectomy
Bilateral Laparoscopic Retroperitoneal Lymph Node Dissection
Robotic-Assisted Retroperitoneal Lymph Node Dissection Port Placement and Technique
Postoperative Care
Prospective Nerve-Sparing Techniques
Complications
Results and Current Status
Laparoscopic Retroperitoneal Lymph Node Dissection for Clinical Stage I Disease
Laparoscopic Retroperitoneal Lymph Node Dissection for Clinical Stage II
Summary
Suggested Readings
References
Chapter 79: Tumors of the Penis
Premalignant Cutaneous Lesions
Non–Human Papillomavirus–Related Penile Premalignant Lesions
Cutaneous Horn
Pseudoepitheliomatous Keratotic and Micaceous Balanitis
Male Lichen Sclerosus (Balanitis Xerotica Obliterans)
Virus-Related Penile Lesions
Human Papillomavirus in Malignant Transformation
Buschke-Löwenstein Tumor (Giant Condyloma Acuminatum)
Carcinoma in situ (Penile Intraepithelial Neoplasia)
Kaposi Sarcoma
Squamous Cell Carcinoma
Invasive Carcinoma
Etiology
Prevention
Natural History
Modes of Presentation
Signs
Symptoms
Diagnosis
Delay
Examination
Biopsy
Histologic Features
Laboratory Studies
Radiologic Studies
Primary Penile Tumor.
Inguinal and Pelvic Region
Current Imaging Strategies Among Clinical Node-Negative Patients.
Current Imaging Strategies Among Clinical Node-Positive Patients.
Penile Cancer Staging
Eighth Edition TNM Penile Staging System.
Tumor Grading.
Definition of the Primary Tumor
Stage Ta Definition.
Stage T1 Definition: Anatomic Detail.
Stage T1 Definition: Inclusion of Perineural Invasion.
Stage T2-T4 Definition Changes.
Pathologic Stage N1-N2 Definitions.
Differential Diagnosis
Surgical Management of the Primary Tumor
Organ Preservation
Circumcision and Limited Excision Strategies
Mohs Micrographic Surgery
Laser Ablation
Contemporary Penile Amputation
Treatment of the Inguinal Nodes
Contemporary Indications for Inguinal Lymphadenectomy
Prognostic Significance of the Presence and Extent of Metastatic Disease
Presence of Palpable Adenopathy as a Selection Factor for Inguinal Dissection
Evolving Indications for Lymphadenectomy in Patients Without Palpable Adenopathy
Immediate Versus Delayed Surgery
Morbidity Versus Benefit
Impact of Primary Tumor Histologic Features on Predicting Occult Nodal Metastasis
Molecular Prognostic Markers
Evolving Indications for Expectant Management of the Inguinal Region
Indications for Modified and Traditional Inguinal Procedures
Modified Procedures
Fine-Needle Aspiration Cytology.
Sentinel Lymph Node Biopsy, Extended Sentinel Lymph Node Dissection, and Node Biopsy.
Dynamic Sentinel Node Biopsy.
Superficial and Modified Complete Inguinal Dissection.
Minimally Invasive Inguinal Lymphadenectomy Using Laparoscopy or Robotic Techniques.
Traditional Inguinal and Ilioinguinal Lymphadenectomy
Risk-Based Management of the Inguinal Region
Very Low-Risk Patients
Low- to Intermediate-Risk Patients (American Joint Committee on Cancer Stage T1a)
High-Risk Patients (American Joint Committee on Cancer Stage T1b or Higher)
Bulky Adenopathy and Fixed Nodal Metastasis
Radiation Therapy
Radiation Therapy for the Primary Lesion
External-Beam Radiotherapy
Brachytherapy
Low-Dose Rate Brachytherapy.
Brachytherapy: High-Dose Rate Interstitial.
Brachytherapy: Surface Mold
Adverse Effects Associated With Radiotherapy
Radiation Therapy for the Inguinal Areas
Chemotherapy
Active Single Agents, Combination Strategies, and Post-Chemotherapy Surgery
Single-Agent Chemotherapy
Combination Chemotherapy
Adjuvant Chemotherapy
Post-Chemotherapy Surgical Consolidation
Nonsquamous Penile Malignant Neoplasms
Basal Cell Carcinoma
Melanoma
Sarcomas
Extramammary Paget Disease
Adenosquamous Carcinoma
Lymphoreticular Malignant Neoplasm
Metastases
References
Chapter 80: Tumors of the Urethra
Benign Urethral Tumors
Leiomyoma
Hemangioma
Fibroepithelial Polyp
Male Urethral Cancer
Epidemiology, Etiology, and Clinical Presentation
Pathology
Evaluation and Staging
Male Anterior Urethral Cancer
Prognosis
Treatment
Carcinoma of the Pendulous Urethra
Carcinoma of the Bulbar Urethra
Male Posterior Urethral Cancer
Female Urethral Cancer
Epidemiology, Etiology, and Clinical Presentation
Anatomy and Pathology
Evaluation and Staging
Prognosis
Treatment
Urethral Recurrence After Radical Cystectomy
Male Urethra
Total Urethrectomy After Cutaneous Diversion
Total Urethrectomy After Orthotopic Diversion
Female Urethra
Acknowledgments
References
Chapter 81: Inguinal Node Dissection
Introduction
Anatomic Background
Penile Lymphatics
Urethral Lymphatics
Inguinal Anatomy
Endoscopic Anatomy of Inguinal Area
Imaging Evaluation of Inguinal Area
Ultrasonography With Fine-Needle Aspiration Cytology
Computed Tomography and Magnetic Resonance Imaging
Magnetic Resonance Imaging With Nanotechnology
Positron Emission Tomography
Penile Cancer: Surgical Management of Regional Lymph Nodes
Penile Cancer: Nonpalpable Inguinal Adenopathy
Sentinel Lymph Node Biopsy
Dynamic Sentinel Lymph Node Biopsy
Technique
Follow-Up
Superficial Inguinal Lymph Node Dissection (SILND)
Modified Inguinal Lymph Node Dissection
Endoscopic and Robotic Inguinal Lymphadenectomy
Background
Surgical Technique
Penile Cancer: Palpable Inguinal Adenopathy or Positive Inguinal Lymph Nodes
Surgery for Curative Purposes
Radical Inguinal Lymph Node Dissection
Adjuvant Chemotherapy
Surgery for Palliative Purposes
Preparation of the Patient Before Surgery
Antibiotics
Anticoagulation
Bowel Cleansing
Postoperative Care of Patients After Inguinal Lymphadenectomy
Bed Rest
Dietary Considerations
Antibiotics
Anticoagulation (see Preparation of the Patient Before Surgery)
Compressive Dressings and Stockings
Drainage
Complications of Inguinal Lymphadenectomy
Oncologic Results and Follow-Up After Surgery
Oncologic Control
Follow-Up
References
Chapter 82: Surgery for Benign Disorders of the Penis and Urethra
Generalities of Reconstructive Surgical Techniques
Principles of Reconstructive Surgery
Grafts
Split-Thickness Skin Graft
Full-Thickness Skin Graft
Dermal Graft
Oral Mucosa Grafts
Vein Grafts
Other Grafts
Flaps
Random Flaps
Axial Flaps
Peninsular Flap
Island Flap
Surgical Anatomy of the Penis and Male Perineum
Penile Anatomy
Urethral Anatomy
Sphincteric Anatomy
Blood Supply
Venous Drainage.
Arterial System.
Lymphatics
Nerve Supply
Perineum
Colles Fascia
Superficial Perineal Space
Central Perineal Tendon (Perineal Body).
Deep Perineal Space.
Selected Processes
Urethral Hemangioma
Reactive Arthritis/Reiter Syndrome
Lichen Sclerosus
Amyloidosis
Urethrocutaneous Fistula
Urethral Diverticulum: Male
Paraphimosis, Balanitis, and Phimosis
Urethral Meatal Stenosis
Circumcision
Transitional Urologic Care for the Patient With Failed Hypospadias and Epispadias Repair
Failed Hypospadias Repair
Failed Epispadias Repair
Urethral Stricture Disease
Urethral Anatomy
Etiology
Iatrogenic
Traumatic
Inflammatory
Idiopathic
Congenital
Diagnosis and Evaluation
Decision Making
Treatment
Dilation
Internal Urethrotomy
Lasers
Stents
Open Reconstruction
Excision and Reanastomosis.
Vessel-Sparing Technique.
Graft Onlay.
Flap Onlay.
Augmented Anastomosis.
Perineal Urethrostomy.
Pelvic Fracture Urethral Injuries
Evaluation
Repair
Postoperative Management
Summary
Vesicourethral Distraction Defects (Vesicourethral Stenosis)
Complex Fistula of the Posterior Urethra
Curvatures of the Penis
Types of Congenital Curvature of the Penis
Chordee Without Hypospadias in Young Men
Congenital Curvatures of the Penis
Acquired Curvatures of the Penis
Acquired Curvatures of the Penis From Causes Other Than Peyronie Disease
Penile Transplantation
General
Reconstruction After Trauma
Female-to-Male Transgender
Suggested Readings
References
Chapter 83: Surgery of the Scrotum and Seminal Vesicles
Surgical Anatomy of the Scrotum
Scrotal Wall
Scrotal Contents
Vasculature
Innervation
Preoperative Considerations
Surgical Approaches to Scrotal Contents
Access Into the Scrotum
Surgeries of the Scrotum
Scrotal Wall
Cyst/Tumor Excision
Partial/Total Scrotectomy
Scrotal Reconstruction
Testis
Hydrocelectomy
Lord Plication.
Jaboulay (Winkelman) Technique.
Bottleneck Technique.
Window Technique.
Aspiration and Sclerotherapy
Technique
Simple Orchiectomy
Technique
Testicular Prosthesis Placement
Epididymis
Excision of Epididymal Cysts and Spermatoceles
Epididymal Tumor Excision
Vas Deferens
Vasectomy
Methods of Vas Isolation
Conventional Vasectomy
Minimally Invasive Vasectomy
No-Scalpel Vasectomy
Vasectomy Reversal
Surgical Management of Chronic Scrotal Pain
Surgical Management of Intrascrotal Pain
Acute and Chronic Epididymitis
Epididymectomy for Palpable Abnormalities of the Epididymis
Microsurgical Spermatic Cord Denervation
Varicocelectomy
Retractile Testis and Intermittent Testicular Torsion
Technique
Testicular Fixation With Suture.
Dartos Pouch Procedure.
Complications of Scrotal Surgery
Bleeding and Postoperative Hematoma
Chronic Scrotal Pain
Early/Late Vasectomy Failure
Epididymal/Vasal Injury or Ligation With Resulting Infertility
Hydrocele Recurrence
Infection
Sperm Granuloma
Anatomy and Embryology of Seminal Vesicles
Surgical Approaches to Seminal Vesicles
Anterior
Perineal
Posterior
Surgeries of the Seminal Vesicles
Seminal Vesicle Cyst Management
Transurethral Endoscopic Treatments
Transrectal Ultrasound–Guided Aspiration
Seminal Vesicle Tumor Excision
Complications of Seminal Vesicle Surgery
Bladder Injury
Endoscopic Surgery Complications
Laparoscopic/Robotic Surgery Complications
Neurovascular Bundle Injury
Rectal Injury
Ureteral Injury
Suggested Readings
References
Part VIII: Renal Physiology and Pathophysiology
Chapter 84: Surgical, Radiologic, and Endoscopic Anatomy of the Kidney and Ureter
Kidneys
Surface Anatomy and Relationships
Gross and Microscopic Anatomy
Radiologic Anatomy of the Renal Parenchyma
Renal Vasculature
Lymphatic Drainage of the Kidney
Innervation of the Kidney
Pelvicalyceal System
Radiologic Anatomy of the Collecting System
Ureters
Radiologic Anatomy of the Ureter
Arteries, Veins, and Lymphatic Drainage of the Ureters
Nerve Supply of the Ureter
Microscopic Anatomy of the Ureter
Endoscopic Anatomy of the Ureter and Pelvicalyceal System
Suggested Readings
References
Chapter 85: Physiology and Pharmacology of the Renal Pelvis and Ureter
Cellular Anatomy
Development of the Ureter
Electric Activity
Resting Potential
Action Potential
Pacemaker Potentials and Pacemaker Activity
Propagation of Electric Activity
Contractile Activity
Contractile Proteins
Calcium and Excitation-Contraction Coupling
Urothelial Effects on Contractile Activity
Second Messengers
Role of the Nervous System in Ureteral Function
Parasympathetic Nervous System
Sympathetic Nervous System
Sensory Innervation and Peptidergic Agents in the Control of Ureteral Function
Purinergic Nervous System
Mechanical Properties
Force-Length Relations
Force-Velocity Relations
Pressure-Length-Diameter Relations
Urine Transport
Physiology of the Ureteropelvic Junction
Propulsion of Urinary Bolus
Effect of Diuresis on Ureteral Function
Effects of Bladder Filling and Neurogenic Vesical Dysfunction on Ureteral Function
Physiology of the Ureterovesical Junction
Pathologic Processes Affecting Ureteral Function
Effect of Obstruction on Ureteral Function
General
Physiologic Methodologies for Assessing Clinical Obstruction
Relation Between Vesicoureteral Reflux and Ureteral Function
Effect of Infection on Ureteral Function
Effect of Calculi and Stents on Ureteral Function
Effect of Diabetes on Ureteral Function
Effect of Age on Ureteral Function
Effect of Pregnancy on Ureteral Function
Effect of Drugs on the Ureter
Histamine and Its Antagonists
Serotonin
Kinins
Angiotensin
Narcotic Analgesics
Prostaglandins
Cardiac Glycosides
Calcium Antagonists
Potassium Channel Openers
Endothelins
Antibiotics
Suggested Readings
References
Chapter 86: Renal Physiology and Pathophysiology Including Renovascular Hypertension
Glomerular Filtration
Nephron Anatomy
Filtrate Transport
Sodium
Potassium
Water
Calcium
Acid-Base Balance
Additional Solutes
Renal Hormone Effects
Vasoconstriction
Vasodilation
Red Blood Cell Production
Bone Mineralization
Pathophysiology and Management of Renovascular Hypertension
Pathophysiology
Diagnosis
Management
Medical Therapy
Percutaneous Intervention
Surgical Treatment
Suggested Readings
Hormonal
Renal Tubular Function
Sodium, Water, and Potassium Imbalances
Acid-Base
Renovascular Hypertension
References
Chapter 87: Renal Insufficiency and Ischemic Nephropathy
Acute Kidney Injury
Prerenal Kidney Injury
Postrenal Kidney Injury
Intrinsic Kidney Injury
Acute Tubular Necrosis Resulting From Ischemic Injury
Contrast Nephropathy
Pigment-Related Kidney Injury
Tumor Lysis Syndrome
Drug Toxicity as a Cause of Acute Kidney Injury
Renal Vein Thrombosis
Clinical Approach to the Differential Diagnosis of Acute Kidney Injury
Management of Acute Kidney Injury
Chronic Kidney Disease
Glomerulonephritis
End-Stage Renal Disease Demographics and Treatment Options
Atherosclerotic Renal Artery Stenosis
Pathophysiology of Hypertension in Atherosclerotic Renal Artery Stenosis
Basic Concepts in Arterial Physiology.
Pathophysiology of Ischemic Nephropathy in Atherosclerotic Renal Artery Stenosis
Diagnostic Evaluation of Atherosclerotic Renal Artery Stenosis
Clinical Features.
Laboratory Features
Radiographic Assessment of Atherosclerotic Renal Artery Stenosis
Therapeutic Options for Atherosclerotic Renal Artery Stenosis
Medical Management.
Procedural Management.
Nonatherosclerotic Renal Artery Diseases
Fibromuscular Dysplasia
Epidemiology of Renal Artery Fibromuscular Dysplasia.
Histopathology of Fibromuscular Dysplasia.
Clinical Presentation.
Diagnostic Evaluation.
Management of Fibromuscular Dysplasia.
Suggested Readings
References
Chapter 88: Urologic Complications of Renal Transplantation
Hematuria
Ureteral Stent Management
Timing of Stent Removal
Retained Stent
Prevention
Diagnosis and Treatment
Urinary Leak
Diagnosis
Treatment
Ureteral Stricture
Diagnosis
Treatment
Vesicoureteral Reflux
Diagnosis
Treatment
Lymphocele
Diagnosis
Treatment
Nephrolithiasis
Treatment
Lower Urinary Tract Complications
Voiding Dysfunction
Small Bladder After Transplant
Benign Prostatic Hyperplasia
Urine Incontinence
Genitourinary Malignancies
Renal Cell Carcinoma
Prostate Cancer
Bladder Cancer
Conclusion
Suggested Readings
References
Part IX: Upper Urinary Tract Obstruction and Trauma
Chapter 89: Management of Upper Urinary Tract Obstruction
Evaluation of Upper Tract Obstruction
Ureteropelvic Junction Obstruction
Pathogenesis
Patient Presentation and Diagnostic Studies
Indications and Options for Intervention
Options for Intervention
Endourologic Management.
Percutaneous Antegrade Endopyelotomy
Indications and Contraindications.
Patient Preparation.
Technique.
Postoperative Care.
Results.
Complications.
Special Considerations.
Retrograde Ureteroscopic Endopyelotomy.
Indications and Contraindications.
Technique.
Results.
Complications.
Other Retrograde Techniques.
Operative Interventions
Historical Notes.
Dismembered Pyeloplasty
Indications.
Technique.
Surgical Approaches for Pyeloplasty
Open Surgery.
Laparoscopic and Robotic Intervention.
Indications and Contraindications.
Techniques.
Transperitoneal Laparoscopic Approach.
Transmesenteric Modification of the Transperitoneal Approach.
Vascular Transposition.
Retroperitoneal Laparoscopic Approach.
Anterior Extraperitoneal Laparoscopic Approach.
Robotic-Assisted Laparoscopic Approach.
Laparoendoscopic Single-Site Surgery Approach.
Postoperative Care and Complications.
Results
Open Approach.
Minimally Invasive Approaches.
Special Situations of Laparoscopic and Robotic-Assisted Laparoscopic Management of Ureteropelvic Junction Obstruction
Laparoscopic and Robotic-Assisted Laparoscopic Ureterocalicostomy.
Laparoscopic and Robotic-Assisted Pyeloplasty With Concomitant Pyelolithotomy.
Laparoscopic Dismembered Tubularized Flap Pyeloplasty.
Laparoscopic Calicovesicostomy.
Other Reconstructive Procedures Involving the Ureteropelvic Junction (Non–Anderson-Hynes)
Flap Procedures
Foley Y-V-Plasty
Indications.
Technique.
Culp-DeWeerd Spiral Flap
Indications.
Technique.
Scardino-Prince Vertical Flap
Indications.
Technique.
Intubated Ureterotomy
Indications.
Technique.
Ureterocalicostomy
Indications.
Technique.
Salvage Procedures.
Postoperative Care and Management of Complications.
Retrocaval Ureter
Etiology and Diagnosis
Operative Intervention
Laparoscopic Surgical Management
Ureteral Stricture Disease
Etiology
Diagnostic Studies and Indications for Intervention
Endourologic Options for Intervention
Ureteral Stent Placement
Balloon Dilation
Retrograde Balloon Dilation.
Antegrade Balloon Dilation.
Results.
Endoureterotomy
Retrograde Ureteroscopic Approach.
Results.
Antegrade Approach.
Combined Retrograde and Antegrade Approach.
Surgical Repair
Ureteroureterostomy
Open Approach.
Laparoscopic or Robotic Approach.
Postoperative Care.
Ureteroneocystostomy
Psoas Hitch
Boari Flap
Renal Descensus
Transureteroureterostomy
Ileal Ureteral Substitution
Minimally Invasive Ileal Ureteral Substitution
Buccal Mucosa Grafting
Autotransplantation
Ureteroenteric Anastomotic Stricture
Incidence and Etiology
Evaluation
Initial Management and Intervention
Endourologic Management
Retroperitoneal Fibrosis
Presentation and Etiology
Evaluation
Management
Initial Management
Medical Management
Surgical Management
Outcomes of Ureterolysis
Suggested Readings
References
Chapter 90: Upper Urinary Tract Trauma
Renal Injuries
Presentation and History
Hematuria
Classification
Indications for Renal Imaging
Imaging Studies
Angioembolization
Nonoperative Management
Operative Management
Renal Exploration
Is Early Vessel Isolation Necessary?
Renal Reconstruction
Renovascular Injuries.
Damage Control
Indications for Nephrectomy
Complications
Ureteral Injuries
Cause
External Trauma
Surgical Injury
Vascular Surgery.
Robotic and Laparoscopic Surgery.
Avoiding and Detecting Ureteral Injury.
Tenuous Ureteral Blood Supply.
Ureteroscopic Injury
Diagnosis
Gunshot and Stab Wounds
Hematuria.
Intraoperative Recognition.
Imaging Studies
Computed Tomography.
Retrograde Ureterography.
Antegrade Ureterography.
Intravenous Pyelography.
Management
General Principles
External Trauma
Contusion.
Upper Ureteral Injuries
Ureteroureterostomy.
Autotransplantation.
Bowel Interposition.
Monitoring After Ureteral Repair.
Nephrectomy.
Midureteral Injuries.
Transureteroureterostomy.
Lower Ureteral Injuries
Ureteroneocystostomy.
Psoas Bladder Hitch.
Boari Flap.
Partial Transection.
Damage Control.
Surgical Injury
Timing of Repair.
Ligation.
Transection
Immediate Recognition.
Delayed Recognition.
Ureteroscopy Injury
Avulsion.
Perforation.
Suggested Readings
References
Part X: Urinary Lithiasis and Endourology
Chapter 91: Urinary Lithiasis: Etiology, Epidemiology, and Pathogenesis
Epidemiology of Renal Calculi
Gender
Race and Ethnicity
Age
Geography
Climate
Occupation
Obesity, Diabetes, and Metabolic Syndrome
Cardiovascular Disease
Chronic Kidney Disease
Water
Physicochemistry and Pathogenesis
State of Saturation
Nucleation and Crystal Growth, Aggregation, and Retention
Inhibitors and Promoters of Crystal Formation
Matrix
Mineral Metabolism
Calcium
Phosphorus
Magnesium
Oxalate
Pathophysiology of Upper Urinary Tract Calculi
Classification of Nephrolithiasis
Calcium Stones
Hypercalciuria
Absorptive Hypercalciuria.
Renal Hypercalciuria.
Resorptive Hypercalciuria.
Hypercalcemic-Induced Hypercalciuria
Sarcoid and Granulomatous Disease.
Malignancy-Associated Hypercalcemia.
Glucocorticoid-Induced Hypercalcemia.
Hyperoxaluria
Primary Hyperoxaluria.
Enteric Hyperoxaluria.
Dietary Hyperoxaluria.
Idiopathic Hyperoxaluria.
Hyperuricosuria
Hypocitraturia
Low Urine pH
Renal Tubular Acidosis
Type 1 (Distal) Renal Tubular Acidosis.
Type 2 (Proximal) Renal Tubular Acidosis.
Type 4 (Distal) Renal Tubular Acidosis.
Hypomagnesiuria
Uric Acid Stones
Pathogenesis of Low Urine pH
Hyperuricosuria
Low Urinary Volume
Cystine Stones
Infection Stones
Pathogenesis
Bacteriology
Epidemiology
Miscellaneous Stones
Xanthine and Dihydroxyadenine Stones
Ammonium Acid Urate Stones
Matrix Stones
Medication-Related Stones
Medications That Directly Promote Stone Formation
Antiretroviral Agents.
Triamterene.
Guaifenesin and Ephedrine.
Silicate Stones.
Medications That Indirectly Promote Stone Formation.
Anatomic Predisposition to Stones
Ureteropelvic Junction Obstruction
Horseshoe Kidneys
Caliceal Diverticula
Medullary Sponge Kidney
Stones in Pregnancy
Suggested Readings
References
Chapter 92: Evaluation and Medical Management of Urinary Lithiasis
Evaluation of Urinary Lithiasis
Epidemiology and Morbidity From Urinary Lithiasis
Imaging for Urinary Lithiasis
Computed Tomography
Radiography (KUB and IVP)
Ultrasound
Other Imaging Modalities
Metabolic Evaluation
First-Time Stone Formers
Defining the High-Risk Stone Former
Screening Evaluation for Newly Diagnosed Stone Formers
Metabolic Evaluation for High-Risk and Recurrent Stone Formers
24-Hour Urine Collection
Economics of Metabolic Evaluation
Stone Analysis
Classification of Nephrolithiasis
General Recommendations for Stone Formers
Fluid Recommendations
Animal Protein
Calcium-Based Calculi
Role of Dietary Calcium
Hypercalciuria (>200 mg/day)
Clinical Considerations
Resorptive Hypercalciuria (Primary Hyperparathyroidism)
Sarcoidosis and Granulomatous Disease
Idiopathic Causes of Hypercalciuria
Calcium Supplementation
Conservative Strategies for Hypercalciuria
Sodium and Hypercalciuria
Medical Therapy for Hypercalciuria
Thiazides and Thiazide-Like Diuretics
Orthophosphate
Sodium Cellulose Phosphate
Hypocitraturia (<550 mg/day Female, <450 mg/day Male)
Clinical Considerations
Conservative Strategies for Hypocitraturia
Citrus Juices
Medical Therapy for Hypocitraturia
Idiopathic Hypocitraturic Calcium Nephrolithiasis
Distal Renal Tubular Acidosis (Type 1)
Chronic Diarrheal States
Thiazide-Induced Hypocitraturia
Hyperoxaluria (>40 mg/day)
Clinical Considerations
Enteric Hyperoxaluria
Primary Hyperoxaluria
Conservative Strategies for Hyperoxaluria
Medical Therapy for Hyperoxaluria
Enteric Hyperoxaluria: Medical Therapy
Medical Therapy for Primary Hyperoxaluria
Other Causes of Calcium Stone Formation
Hyperuricosuric Calcium Oxalate Nephrolithiasis
Hypomagnesuric Calcium Nephrolithiasis (<80 mg)
Uric Acid Stones
Clinical Considerations
Low Urine pH
Diabetes, Obesity, and Metabolic Syndrome
Diagnosis
Conservative Treatment for Uric Acid Stone Prevention
Medical Treatment for Uric Acid Stone Prevention
Cystinuria
Clinical Considerations
Conservative Strategies for Cystine Stone Prevention
Medical Therapy for Cystine Stone Prevention
Follow-Up
Compliance and Quality of Life
Infection Calculi
Miscellaneous and Drug-Induced Stones
Drug-Containing Calculi
Drugs That Induce Metabolic Stone Formation
Ammonium Acid Urate Stones
Medical Management of Bladder Calculi
Follow-Up Considerations in the Medical Management of Urinary Lithiasis
References
Chapter 93: Strategies for Nonmedical Management of Upper Urinary Tract Calculi
Kidney Calculi
Ureteral Calculi
Rise of Endourology
Ureterorenoscopy
Percutaneous Stone Removal
Extracorporeal Shock Wave Lithotripsy
Renal Calculi
Natural History
Nonstaghorn Renal Calculi
Staghorn Calculi
Pretreatment Assessment
Medical History
Imaging
Laboratory Tests
Stone Factors
Treatment Decision by Stone Burden
Kidney Stone Burden Up to 1 cm.
Kidney Stone Burden Between 1 and 2 cm.
Kidney Stone Burden Greater Than 2 cm.
Staghorn Stones
Treatment Decision by Stone Localization
Treatment by Stone Composition
Matrix
Cystine.
Brushite.
Medication-Precipitated Stones.
Renal Anatomic Factors
Ureteral Pelvic Junction Obstruction
Calyceal Diverticula
Horseshoe Kidneys and Renal Ectopia
Horseshoe Kidneys.
Renal Ectopia.
Lower Pole Calculi
Ureteral Calculi
Natural History
Pretreatment Assessment
Stone Factors
Treatment Decision by Localization
Proximal and Mid-Ureter.
Distal Ureter.
All Locations.
Treatment Decision by Stone Burden
Treatment by Stone Composition
Ureteral Anatomic Factors
Megaureter
Duplicated Collecting System
Ureteral Stricture or Stenosis
Technical Factors
Clinical Factors for Upper Urinary Tract Calculi
Urinary Tract Infection
Renal Function
Solitary Kidney
Morbid Obesity
Old Age and Frailty
Spinal Deformity or Limb Contractures
Uncorrected Coagulopathy
Prior Renal Surgery
Urinary Diversion
Renal Transplants
Duration of Ureteral Stone Presence
Evaluation of Outcome
Assessment and Fate of Residual Fragments
Suggested Readings
References
Chapter 94: Surgical Management for Upper Urinary Tract Calculi
Extracorporeal Shock Wave Lithotripsy
Methods and Physical Principles
Generator Type
Electrohydraulic (Spark Gap) Generator.
Electromagnetic Generator.
Piezoelectric Generator.
Imaging Systems
Fluoroscopy Alone.
Ultrasonography Alone.
Combination of Ultrasonography and Fluoroscopy.
Stone Fragmentation
Bioeffects: Clinical Studies
Acute Extrarenal Damage
Acute Renal Injury: Structural and Functional Changes
Chronic Renal Injury: Structural and Functional Changes
Mechanism for Tissue Injury
Techniques to Optimize Shock Wave Lithotripsy Outcome
Adjuncts to Improve Shock Wave Lithotripsy Outcomes
Future Direction
Percutaneous Nephrolithotomy
Preparation of the Patient
Antibiotics
Anesthesia
Stone Removal
Technique Modifications
Special Situations
Calyceal Diverticula
Horseshoe Kidney
Transplantation and Pelvic Kidneys
Staghorn Calculi or Complex Stones
Morbid Obesity
Complications
Ureteroscopic Stone Management
Complications
Perforation
Stricture
Submucosal Stone and Lost Stone
Avulsion
Intracorporeal Lithotripsy
Flexible Lithotripters
Electrohydraulic Lithotripsy
Advantages and Disadvantages.
Laser Lithotripsy
Advantages and Disadvantages.
Technique.
Laser Lithotripsy Approaches
Fragmentation and Extraction.
Dusting.
Rigid Lithotripters
Ballistic Lithotripsy
Advantages and Disadvantages.
Technique.
Ultrasonic Lithotripsy
Advantages and Disadvantages.
Technique.
Combination Ballistic and Ultrasonic Devices
Laparoscopic and Robotic Stone Removal
References
Chapter 95: Lower Urinary Tract Calculi
History
Etiopathogenesis of Bladder Calculi
Presentation of Bladder Stones
Management of Bladder Stones
Medical Management
Extracorporeal Shock Wave Lithotripsy
Endourologic Approach to Bladder Stone
Open Surgery for Bladder Stones
Lower Tract Calculi in Special Situations
Bladder Outlet Obstruction With Bladder Lithiasis
Bladder Calculi in Urinary Diversions and Augmented Bladder
Bladder Calculi in Patients With Spinal Cord Injury
Bladder Calculi After Renal Transplantation
Urethral Calculi
Pathogenesis and Composition of Urethral Calculi
Primary Urethral Calculi
Clinical Presentation and Evaluation
Treatment
Unusual Lower Tract Urolithiasis
Preputial Calculi
Prostatic Calculi
Etiopathogenesis and Composition.
Clinical Presentation.
Evaluation and Management.
Suggested Readings
References
Part XI: Neoplasms of the Upper Urinary Tract
Chapter 96: Benign Renal Tumors
Diagnosis
Renal Cysts
Epidemiology, Etiology, and Pathophysiology
Natural History
Evaluation
Management Options
Oncocytoma
Epidemiology and Etiology
Pathophysiology
Evaluation
Management
Angiomyolipoma
Epidemiology
Pathophysiology
Diagnosis
Management
Papillary Adenoma of the Kidney
Metanephric Adenoma
Mixed Mesenchymal and Epithelial Tumors
Cystic Nephroma
Mixed Epithelial and Stromal Tumors
Leiomyoma
Other Benign Renal Tumors
Suggested Readings
References
Chapter 97: Malignant Renal Tumors
Historical Considerations
Classification
Imaging and Clinical Risk Stratification of Renal Masses
Radiographic Evaluation of Renal Masses
Evaluation of Cystic Renal Lesions
Renal Cell Carcinoma
Incidence
Etiology
Familial Renal Cell Carcinoma and Molecular Genetics
von Hippel-Lindau Disease, VHL Gene, and Genetics of Clear Cell RCC
Hereditary Papillary Renal Carcinoma Syndrome
Hereditary Leiomyomatosis and Renal Cell Carcinoma
Succinate Dehydrogenase Renal Cell Carcinoma
Birt-Hogg-Dube Syndrome
Cowden Syndrome
Tuberous Sclerosis Complex
Microphthalmia-Associated Transcription Factor–Associated Cancer Syndrome
Tumor Biology and Clinical Implications
Resistance to Cytotoxic Therapy
Immunobiology and Immune Tolerance
Angiogenesis and Targeted Pathways
Cancer Genome Research
Other Signal Transduction and Cell Cycle Regulation Pathways
Pathology
Clear Cell Renal Cell Carcinoma
Papillary Renal Cell Carcinoma
Chromophobe Renal Cell Carcinoma
Collecting Duct Carcinoma
Renal Medullary Carcinoma
Sarcomatoid and Rhabdoid Differentiation
Unclassified Renal Cell Carcinoma
Clinical Presentation
Screening and Clinical Associations
Staging
Prognosis
Treatment of Localized Renal Cell Carcinoma
American Urological Association Guidelines for Renal Mass and Localized Renal Cancer
Risk Stratification and Renal Mass Biopsy
Renal Function After Partial or Radical Nephrectomy: Survival Implications
Radical Nephrectomy
Partial Nephrectomy
Tumor Enucleation
Thermal Ablative Therapies
Active Surveillance
Nephron-Sparing Surgery in von Hippel-Lindau and Other Forms of Familial Renal Cell Carcinoma
Treatment of Locally Advanced Renal Cell Carcinoma
Inferior Vena Cava Involvement
Locally Invasive Renal Cell Carcinoma
Lymph Node Dissection for Renal Cell Carcinoma
Local Recurrence After Radical Nephrectomy or Nephron-Sparing Surgery
Neoadjuvant and Adjuvant Therapy for Renal Cell Carcinoma
Other Malignant Renal Tumors
Sarcomas of the Kidney
Renal Lymphoma and Leukemia
Metastatic Tumors
Other Malignant Tumors of the Kidney
Suggested Readings
References
Chapter 98: Urothelial Tumors of the Upper Urinary Tract and Ureter
Epidemiology
Incidence
Gender, Race, Age Variations, and Familial Predisposition
Mortality Rate
Risk Factors
Genetic Predisposition
Environmental Factors
Tobacco Exposure
Coffee, Tea, and Yerba Mate
Occupation
Aristolochic Acid Nephropathy
Analgesics
Arsenic
Chronic Inflammation and Infection
Iatrogenic Factors
Histopathology
Normal Upper Tract Urothelium
Renal Pelvis and Calyces
Ureter
Urothelial Neoplasms
Benign Lesions: Papillomas and von Brunn Nests
Metaplastic and Dysplastic Lesions
Urothelial Malignant Lesions
Urothelial Carcinoma.
Micropapillary Variant of Urothelial Carcinoma.
Nonurothelial Malignant Lesions
Squamous Cell Carcinoma.
Adenocarcinoma.
Other Tumors.
Diagnosis
Endoscopy of the Lower Tract
Cystoscopy
Endoscopy of the Upper Tract
Ureterorenoscopic Evaluation
Antegrade Endoscopic Evaluation
Radiologic Imaging
Cytology and Tumor Markers
Staging and Classification
Natural History
Recurrence
Involvement of the Ureter or Renal Collecting System
Synchronous and Asynchronous Localizations
Upper Tract Recurrence After Bladder Cancer.
Bladder Recurrence After Upper Tract Tumors.
Carcinoma in Situ.
Metastatic Potential of Upper Urinary Tract Carcinoma
Dissemination of Disease.
Lymphatic.
Hematogenous.
Epithelial.
Panurothelial Disease.
Prognosis
TNM Classification
Histologic Grading
Prognostic Factors
Preoperative Factors
Age-Sex-Ethnicity.
Tobacco Consumption.
Tumor Location.
Surgical Delay.
Other.
Postoperative Factors
Tumor Stage and Grade.
Lymph Node Involvement.
Lymphovascular Invasion.
Surgical Margins
Molecular Markers
Cell Cycle Markers.
Apoptosis.
Cell Migration and Invasion.
Angiogenesis.
Cell Proliferation.
Cell Differentiation.
Mitosis.
Other Markers
Predictive Tools
Risk Stratification
References
Chapter 99: Surgical Management of Upper Urinary Tract Urothelial Tumors
Diagnosis
Ureteroscopic Evaluation and Biopsy
Treatment Algorithm
Surgical Management
Radical Nephroureterectomy
Indications
Techniques
Open Radical Nephrectomy.
Management of Distal Ureter and Bladder Cuff.
Traditional Open Distal Ureterectomy.
Transvesical Ligation and Detachment Technique.
Transurethral Resection of the Ureteral Orifice.
Intussusception (Stripping) Technique.
Total Laparoscopic Technique.
Laparoscopic Radical Nephroureterectomy
Indications
Technique
Transperitoneal Laparoscopic Nephroureterectomy
Laparoscopic Removal of Kidney Down to Mid-Ureter.
Proximal Ureteronephrectomy.
Open Distal Ureterectomy With Excision of Bladder Cuff.
Dissection of the Distal Ureter.
Robot-Assisted Laparoscopic Nephroureterectomy.
Results
Lymphadenectomy
Results
Segmental Ureteral Resection
Open Segmental Ureterectomy
Ureteroureterostomy
Indications.
Technique.
Distal Ureterectomy and Direct Neocystostomy or Ureteroneocystostomy With a Bladder Psoas Muscle Hitch or a Boari Flap.
Ileal Ureteral Replacement
Laparoscopic or Robotic Distal Ureterectomy and Reimplantation
Results
Endourologic Management
Basic Attributes
Retrograde Ureteroscopic
Ureteroscopy and Ureteropyeloscopy
Technique and Instrumentation.
Endoscopic Evaluation and Collection of Urine Cytology Specimen.
Tumor Confined to the Intramural Ureter
Biopsy and Definitive Treatment.
Ureteroscopic Techniques.
Results
Antegrade Nephroureteroscopic
Technique and Instrumentation
Establishment of the Nephrostomy Tract.
Biopsy and Definitive Therapy.
Second-Look Nephroscopy.
Results
Consideration for Urinary Diversions
Management of Positive Upper Tract Urinary Cytology and Carcinoma in situ
Evaluation
Carcinoma in situ of the Upper Urinary Tracts
Expectant Management
Adjuvant Topical Therapy
Adjuvant Intravesical Topical Chemotherapy After Nephroureterectomy to Decrease Bladder Recurrence.
Technique
After Organ-Sparing Therapy
Instillation Therapy.
Results
Systemic Chemotherapy.
Treatment of Lymph Node–Positive and Metastatic Disease
Chemotherapy
Immunotherapy
Anti–PD-1 Approved Therapies.
Anti–PD-L1 Approved Therapies.
Molecular Alterations and Future of Genomic-Driven Therapy
Radiotherapy
Follow-Up
Issues in Assessing for Recurrence
General Procedures
Specific Procedures
Metastatic Restaging
References
Chapter 100: Retroperitoneal Tumors
Overview
Anatomic Considerations of the Retroperitoneum
Initial Evaluation of the Retroperitoneal Mass
Differential Diagnosis
Germ Cell/Gonadal Origins
Germ Cell Tumor
Sex Cord Stromal Tumor
Mesodermal Origins
Liposarcoma
Pleomorphic Liposarcoma
Leiomyosarcoma
Malignant Fibrous Histiocytoma/Undifferentiated Pleomorphic Sarcoma
Synovial Sarcoma
Solitary Fibrous Tumor
Ewing and Ewing-Like Sarcoma
Desmoplastic Small Round Cell Tumors
Unclassified Sarcomas
Perivascular Epitheliod Cell Tumor
Desmoid Tumor
Neurogenic Origins
Tumors of Sympathetic Ganglia
Tumors of Paraganglionic System
Tumors of Nerve Sheath Origin
Hematologic Conditions/Lymphomas of the Retroperitoneum
Lymphomas
Plasmacytoma
Cystic Masses
Cystic Lymphangioma
Mucinous Cystadenoma
Cystic Mesothelioma
Cystic Change of Solid Retroperitoneal Tumors
Retroperitoneal Cancer of Unknown Primary Origin
Surgical Management of the Retroperitoneal Tumor
Preoperative Considerations
Surgical Technique
Exposure of the Retroperitoneum
Approach to the Retroperitoneum
Split-and-Roll Technique.
Left Para-Aortic Region.
Interaortocaval Region.
Right Paracaval Region.
Surgical Modifications
Template Considerations for Management of Metastatic Germ Cell Tumors
Primary Retroperitoneal Lymph Node Dissection.
Postchemotherapy Retroperitoneal Lymph Node Dissection.
Nerve-Sparing RPLND.
Auxiliary Procedures
Nephrectomy.
Vascular Reconstruction
Aortic Replacement
Vena Caval Resection
Tumor Thrombectomy
Complications
Ejaculatory Function
Vascular
Lymphatic
Lymphocele.
Chylous Ascites.
Neurologic
Postoperative Care
Disease-Specific Neoadjuvant and Adjuvant Therapies
Radiation
Chemotherapy and Systemic Therapies
Conclusions
References
Chapter 101: Open Surgery of the Kidney
Historical Perspective
Preoperative Evaluation and Preparation
Prophylactic Measures
Surgical Instruments
Surgical Approaches
Flank Approaches
Subcostal Flank Approach
Supracostal Flank Approach
Dorsal Lumbotomy Approach
Thoracoabdominal Approach
Anterior Approaches
Anterior Midline Approach
Anterior Subcostal Approach
Chevron Incision (Bilateral Anterior Subcostal Approach)
Surgery for Benign Diseases
Simple Nephrectomy
Partial Nephrectomy for Benign Disease
Open Nephrostomy
Extracorporeal Renal Surgery
Preoperative Considerations
Surgical Procedure
Surgery for Malignancy
Radical Nephrectomy
Surgical Procedure
Regional Lymphadenectomy for Renal Cancer
Wound Closure
Intra- and Postoperative Complications
Damage During Suprahilar and Retrocrural Lymphadenectomy.
Injury to the Vasculature of the Gut.
Injury to the Liver and Spleen.
Injury to the Duodenum.
Injury to the Pancreas.
Pulmonary Complications.
Partial Nephrectomy for Malignant Disease
Preoperative Considerations
Hyperfiltration Injury.
Renal Ischemia and Hypothermia.
Enucleation and Surgical Margin.
Multifocality and Tumor Size.
Hereditary Renal Malignancy.
Enucleation for Small Cortical Tumors
Wedge Resection for Large Cortical Tumors
Segmental Nephrectomy for Large Polar Tumors
Complications Associated With Partial Nephrectomy
Urinary Fistulae.
Postoperative Bleeding.
Renal Insufficiency.
Vena Caval Thrombectomy
Preoperative Considerations
Pulmonary Embolism, Anticoagulation, and IVC Filters.
Tumor Thrombus Level.
Level I Vena Caval Thrombectomy: Right-Sided Tumor
Level II Vena Caval Thrombectomy: Left-Sided Tumor
Level III-IV Vena Caval Thrombectomy: Intra-Abdominal Approach
Level III-IV Vena Caval Thrombectomy: Combined Intra-Abdominal and Intrathoracic Approach
Bypass Techniques for Inferior Vena Caval Surgery
Venovenous Bypass.
Cardiopulmonary Bypass With and Without Deep Hypothermic Arrest.
Patching, Replacing, and Interrupting the Inferior Vena Cava
Patch Cavoplasty.
Vena Caval Replacement.
Inferior Vena Cava Filtration and Permanent Interruption for Bland Thrombus
Perioperative Complications
Air Embolism.
Acute Pulmonary Embolism.
Massive Hemorrhage.
Hepatic Dysfunction.
Organ Ischemia.
Suggested Readings
References
Chapter 102: Laparoscopic and Robotic Surgery of the Kidney
Patient Evaluation and Preparation
Anesthetic Considerations for Laparoscopy
Considerations in Obese Patients
Considerations in Elderly Patients
Surgical Approaches and Obtaining Access
Transperitoneal Approach
Patient Positioning and Trocar Placement
Retroperitoneal Approach
Patient Positioning and Trocar Placement
Hand-Assisted Laparoscopy
Patient Positioning and Trocar Placement
Robotic-Assisted Laparoscopy
Patient Positioning and Trocar Placement
Laparoendoscopic Single-Site Surgery and Natural Orifice Transluminal Endoscopic Surgery
Patient Positioning and Trocar Placement
Simple Nephrectomy
Procedure
Reflection of the Colon
Dissection of the Ureter
Identification of the Renal Hilum
Securing the Renal Blood Vessels
Dissection of the Upper Pole
Organ Entrapment and Extraction
Postoperative Management
Results
Surgery for Renal Cystic Disease
Procedure
Results
Renal Biopsy for Medical Renal Disease
Procedure
Results
Nephropexy
Procedure
Results
Calyceal Diverticulectomy
Procedure
Results
Nephrolysis
Procedure and Results
Radical Nephrectomy
Transperitoneal
Procedure
Results
Retroperitoneal
Procedure
Results
Hand-Assisted
Procedure
Results
Special Considerations
Large Tumors
En Bloc Hilar Vessel Stapling
Tumor Seeding and Port-Site Recurrence
Specimen Extraction
Lymphadenectomy
Local Recurrence
Renal Vein and Caval Tumor Thrombus
Cytoreductive Nephrectomy
Surgical Salvage After Failed Ablative Therapies
Partial Nephrectomy
Indications
Clinical Stage T1b and Greater Tumors
Laparoscopic Heminephrectomy
Central and Hilar Tumors
Tumor in a Solitary Kidney
Multiple Tumors
Repeat Partial Nephrectomy
Other Indications
Procedure
Transperitoneal Laparoscopic Partial Nephrectomy
Retroperitoneal Laparoscopic Partial Nephrectomy
Robotic-Assisted Laparoscopic Partial Nephrectomy
Tumor Localization and Excision
Hemostasis
Collecting System Repair
Renal Hypothermia
Warm Ischemia and Hilar Control
Off-Clamp Partial Nephrectomy.
Selective Arterial Clamping.
Parenchymal Compression.
Results
Positive Surgical Margins
Laparoscopic Ablative Techniques
Cryoablation
Radiofrequency Ablation
Results
Complications
Laparoendoscopic Single-Site Surgery of the Kidney
Renal Laparoendoscopic Single-Site Surgery
Robotic Laparoendoscopic Single-Site Surgery
Complications ff Laparoscopic Renal Surgery
Vascular Complications
Urinary Complications
Visceral and Bowel Complications
Other Complications
Minimally Invasive Renal Surgery in Urologic Practice
Summary
Suggested Readings
References
Chapter 103: Nonsurgical Focal Therapy for Renal Tumors
Cryoablation
Background and Mode of Action
Treatment Temperature
Freeze-Thaw Cycles
Duration of Treatment
Radiofrequency Ablation
Background and Mode of Action
Variations in Radiofrequency Ablation Equipment
Treatment Temperature
Intraoperative Monitoring
Surgical Technique
Transperitoneal and Retroperitoneal Laparoscopic Renal Cryoablation and Radiofrequency Ablation
Percutaneous Renal Cryoablation and Radiofrequency Ablation (See Video 103.1)
Treatment Success and Follow-Up Protocol After Tumor Ablation
Radiographic Interpretation of Success
Recommended Radiographic Follow-Up Protocol
Role of Preablation and Postablation Biopsy
Oncologic Outcomes
Local Recurrence-Free Survival
Metastatic Recurrence-Free Survival
Cancer-Specific Survival
Overall Survival
Cryoablation Versus Radiofrequency Ablation
Laparoscopic Versus Percutaneous Renal Tumor Ablation
Complications
New Ablation Modalities
High-Intensity Focused Ultrasonography
Radiation Therapy
Microwave Ablation
Irreversible Electroporation
Targeted Embolization and Ablation
Conclusion
Suggested Readings
References
Chapter 104: Treatment of Advanced Renal Cell Carcinoma
Prognostic Factors
Surgical Management of Metastatic Renal Cell Carcinoma
Debulking or Cytoreductive Nephrectomy in Patients With Metastatic Renal Cell Carcinoma
Resection of Metastases
Palliative Surgery
Immunologic Approaches in the Management of Advanced Clear Cell Renal Cell Carcinoma
Interferons
Interleukin-2
Allogeneic Hematopoietic Stem Cell Transplantation
Immune “Checkpoint” Inhibitors
Molecular Basis for Targeted Approaches in Clear Cell Renal Cell Carcinoma
Targeted Molecular Agents in Clear Cell Renal Cell Carcinoma
Antagonists of the Vascular Endothelial Growth Factor Pathway
Bevacizumab
Sorafenib
Sunitinib
Pazopanib
Axitinib
Newer VEGFR-Based Targeted Therapy Strategies
Cabozantinib
Lenvatinib
Inhibitors of the Mammalian Target of Rapamycin
Combination and Sequential Therapy With Agents Targeting the VHL Pathway
Immune “Checkpoint” Inhibitor–Based Combination Strategies
Other Treatment Options in Patients With Clear Cell Renal Cell Carcinoma
Chemotherapy
Hormonal Therapy
Systemic Therapy for Non–Clear Cell Variants of Renal Cell Carcinoma
Suggested Readings
References
Part XII: The Adrenals
Chapter 105: Surgical and Radiographic Anatomy of the Adrenals
Anatomic Relationships
Surgical Landmarks
Adrenal Vasculature
Adrenal Nerves
Embryology
Histology
Radiology
Computed Tomography
Magnetic Resonance Imaging
Ultrasonography
Angiography
Conclusion
Suggested Readings
References
Chapter 106: Pathophysiology, Evaluation, and Medical Management of Adrenal Disorders
Historical Background
Adrenal Anatomy and Embryology
Overview
Embryology
Anatomy
Histology
Adrenal Physiology
Adrenal Cortex Physiology
Zona Glomerulosa
Zona Fasciculata
Zona Reticularis
Adrenal Medulla Physiology
Adrenal Disorders
Disorders of Increased Adrenal Function
Cushing Syndrome
Overview and Epidemiology.
Pathophysiology.
Normal Hypothalamic-Pituitary-Adrenal Axis Physiology.
Overview of Cushing Syndrome.
Exogenous Cushing Syndrome.
Adrenocorticotropic Hormone–Dependent Cushing Syndrome
Overview.
Cushing Disease.
Ectopic Adrenocorticotropic Hormone Syndrome.
Ectopic Corticotropin-Releasing Hormone.
Adrenocorticotropic Hormone–Independent Cushing Syndrome.
Adrenal Tumors.
Adrenocorticotropic Hormone–Independent Macronodular Adrenal Hyperplasia.
Primary Pigmented Nodular Adrenocortical Disease.
Clinical Characteristics
Classical Cushing Syndrome.
Autonomous Cortisol Secretion (Subclinical Cushing Syndrome).
Diagnostic Tests.
Establishing the Diagnosis of Cushing Syndrome.
Identifying the Cause of Cushing Syndrome.
Treatment.
Exogenous Cushing Syndrome.
Adrenocorticotropic Hormone–Dependent Disease
Cushing Disease.
Ectopic Adrenocorticotropic Hormone Syndrome.
Adrenocorticotropic Hormone-Independent Disease.
Medical Treatment of Hypercortisolism.
Prognosis.
Summary.
Primary Aldosteronism
Overview and Epidemiology.
Pathophysiology.
Clinical Characteristics.
Diagnostic Tests.
Screening.
Confirmatory Testing.
Subtype Differentiation.
Treatment and Prognosis.
Summary.
Pheochromocytoma
Overview and Epidemiology.
Pathophysiology
Overview.
Pathophysiology of Hereditary Pheochromocytoma.
Pathophysiology of Malignant Pheochromocytoma.
Clinical Characteristics
Overview.
Clinical Characteristics of Hereditary Pheochromocytoma.
Clinical Characteristics of Malignant Pheochromocytoma.
Diagnostic Tests.
Imaging.
Cross-Sectional Imaging.
Functional Imaging
Positron Emission Tomography.
Metaiodobenzylguanidine Scintigraphy.
Other Functional Imaging Modalities.
Biochemical Evaluation
Overview.
Catecholamine Testing.
Metanephrine Testing.
Vanillylmandelic Acid Testing.
Clonidine Suppression Testing.
Chromogranin A Testing.
Screening for Hereditary Pheochromocytoma.
Treatment
Overview.
Preoperative Management
Overview.
α-Blockade.
β-Blockade.
Catecholamine Synthesis Blockade.
Calcium Channel Blockade.
Intravascular Volume Management.
Postoperative Management.
Follow-Up.
Treatment of Hereditary Pheochromocytoma.
Treatment of Malignant Pheochromocytoma.
Prognosis.
Summary.
Disorders of Decreased Adrenal Function
Overview and Epidemiology
Pathophysiology
Clinical Characteristics
Diagnostic Tests
Treatment
Prognosis
Summary
Disorders of Abnormal Adrenal Function
Congenital Adrenal Hyperplasia
Adrenal Lesions
Malignant
Adrenal Carcinoma
Overview and Epidemiology.
Pathophysiology.
Clinical Characteristics.
Diagnostic Tests.
Pathologic Evaluation.
Staging.
Management.
Surgery.
Radiation.
Medical Therapy.
Prognosis.
Pediatric Adrenocortical Carcinoma.
Summary
Neuroblastoma.
Metastases
Overview and Epidemiology.
Pathophysiology and Clinical Characteristics.
Diagnostic Tests.
Treatment and Prognosis.
Summary.
Malignant Pheochromocytoma.
Benign
Adenoma
Overview and Epidemiology.
Pathophysiology and Clinical Characteristics.
Diagnostic Tests.
Treatment.
Prognosis.
Summary.
Oncocytoma
Overview and Epidemiology.
Pathophysiology and Clinical Characteristics.
Diagnostic Tests and Treatment.
Prognosis.
Summary.
Myelolipoma
Overview and Epidemiology.
Pathophysiology.
Clinical Characteristics.
Diagnostic Tests.
Treatment.
Prognosis.
Summary.
Ganglioneuroma
Overview and Epidemiology.
Pathophysiology/Clinical Characteristics.
Diagnostic Tests.
Treatment and Prognosis.
Summary.
Adrenal Cysts
Overview and Epidemiology.
Pathophysiology.
Clinical Characteristics.
Diagnostic Tests.
Treatment.
Prognosis.
Summary.
Benign Pheochromocytoma.
Evaluation of Adrenal Lesions in Urologic Practice
Overview of the Adrenal Incidentaloma
Imaging of Adrenal Masses
Imaging Modalities
Ultrasonography.
Computed Tomography and Magnetic Resonance Imaging.
Unenhanced Computed Tomography.
Enhanced Computed Tomography.
Computed Tomography Washout Study.
Magnetic Resonance Imaging.
Functional Imaging.
Size and Growth
Biopsy of Adrenal Masses
Overview
Test Characteristics of Biopsy
Complications of Biopsy
Clinical Usefulness of Biopsy
Assessment of Function of Adrenal Masses
Overview
Testing for Cortisol Hypersecretion
Overnight Low-Dose Dexamethasone Suppression Test.
Late-Night Salivary Cortisol.
24-Hour Urinary Free Cortisol Evaluation.
Testing for Aldosterone Hypersecretion
Testing for Adrenal Sex Steroid Hypersecretion
Testing for Catecholamine Hypersecretion
Plasma Free Metanephrines.
24-Hour Urinary Fractionated Metanephrines.
Follow-Up
Summary of Surgical Indications
Conclusions
Suggested Readings
References
Chapter 107: Surgery of the Adrenal Glands
Evolution of Adrenal Surgery
Surgical Anatomy
Clinical Indications for Adrenalectomy
Indications and Contraindications for Laparoscopic Adrenalectomy
Past Surgical and Medical History
Tumor Size
Adrenal Cortical Carcinoma
Preoperative and Perioperative Management
Pheochromocytoma
Conn Syndrome
Cushing Syndrome
Open Adrenalectomy
Flank Retroperitoneal Approach
Positioning
Incision
11th Rib Excision
Creating the Retroperitoneal Space
Dissection of Adrenal Gland
Closure
Posterior Lumbodorsal Approach
Positioning
Incision and Rib Excision
Dissection of Adrenal Gland
Anterior Transabdominal Approach
Left Adrenalectomy
Positioning and Incision.
Approach to Left Adrenal Gland.
Closure.
Right Adrenalectomy
Thoracoabdominal Approach
Positioning.
Incision and Dissection of Adrenal Gland.
Closure.
Laparoscopic Adrenalectomy
Transperitoneal Approach
Transperitoneal Lateral Approach: Left Adrenalectomy
Positioning and Ports Placement.
Mobilization of Colon and Spleen.
Ligation of Left Adrenal Vein and Mobilization of the Left Adrenal Gland.
Closure.
Transperitoneal Lateral Approach: Right Adrenalectomy
Gasless Laparoscopic Transperitoneal Approach
Retroperitoneal Approach
Retroperitoneal Lateral Adrenalectomy: Left Adrenalectomy
Positioning and Ports Placement.
Ligation of Left Adrenal Vein and Mobilization of Left Adrenal Gland.
Closure.
Retroperitoneal Lateral Adrenalectomy: Right Adrenalectomy
Robot-Assisted Adrenalectomy
Robot-Assisted Lateral Transperitoneal Adrenalectomy
Robot-Assisted Posterior Retroperitoneal Adrenalectomy
Hand-Assisted Surgery
Laparoendoscopic Single-Site Adrenalectomy
Natural Orifice Transluminal Endoscopic Surgery–Assisted Laparoscopic Adrenalectomy
Partial Adrenalectomy
Outcomes
Open Versus Laparoscopic Adrenalectomy
Laparoscopic Transperitoneal Versus Retroperitoneal Approach
Laparoscopic Versus Robot-Assisted Adrenalectomy
Complications
Intraoperative
Postoperative
Ablative Therapy for Adrenal Tumors
Future of Adrenal Surgery
Suggested Readings
References
Part XIII: Urine Transport, Storage, and Emptying
Chapter 108: Surgical, Radiographic, and Endoscopic Anatomy of the Female Pelvis
Surgical Anatomy of the Female Pelvis
Bony Pelvis
Fascia and Peritoneum
Spaces Among Pelvic Organs
Ligaments
Muscles of the Pelvic Floor
Pelvic Sidewalls
Pelvic Floor
Vasculature
Arterial Supply
Venous Supply
Lymphatic Drainage
Nerves of the Pelvis
Somatic Innervation
Autonomic Innervation
Perineum
Anal Perineum
External Genitalia
Female Pelvic Organs
Pelvic Organ Support
Urethra
Radiographic Anatomy of the Female Pelvis
Ultrasound
Pelvic Magnetic Resonance Imaging
Fluoroscopy
Endoscopic Anatomy
References
Chapter 109: Surgical, Radiographic, and Endoscopic Anatomy of the Male Pelvis
Bony Pelvis
Lower Abdominal Wall
Skin and Subcutaneous Fascia
Musculature
Inguinal Canal
Internal Peritoneal Elevations
Soft Tissues of the Pelvis
Musculature
Pelvic Fascia
Perineum
Perineal Fascia
Anal Triangle
Urogenital Triangle
Pelvic Circulation
Arterial Supply
Venous Supply
Pelvic Lymphatics
Pelvic Innervation
Motor Nerves
Autonomic Nerves of the Pelvis
Pelvic Viscera
Rectum
Bladder
Ureterovesical Junction
Blood Supply and Lymphatic Drainage of the Bladder
Innervation of the Bladder
Pelvic Ureter
Endoscopic Anatomy
Radiographic Anatomy
Pelvic Radiographs and Fluoroscopy
Computed Tomography
Magnetic Resonance Imaging
References
Chapter 110: Physiology and Pharmacology of the Bladder and Urethra
Lower Urinary Tract Anatomy
Bladder Compartments
Urothelium
Lamina Propria and Vasculature
Stroma
Bladder Wall Collagen
Bladder Wall Elastin and Matrix
Smooth Muscle
Overview of the Urethra
Male Urethra
Female Urethra
Anatomy Common to Both Genders
Fiber Types of Urethral Striated Muscle
Urothelial Physiology
Barrier Function
Urethral Tone
Ionic Transport
Sensor-Transducer Function of the Urothelium
Suburothelial Interstitial Cells
Smooth Muscle Physiology
Contractile Proteins
Actinomyosin Cross-Bridge Cycling
Membrane Electrical Properties and Action Potentials
Excitation-Contraction Coupling
Calcium Signaling in Detrusor Myocyte
Propagation of Electrical Responses
Detrusor Interstitial Cells
Bladder Mechanics
Urinary Storage (Filling)
Voiding Mechanics
Motor Sensory Network in Detrusor Muscle
Neural Control of the Lower Urinary Tract
Peripheral Nervous System
Parasympathetic Pathways
Sympathetic Pathways
Somatic Pathways
Afferent Pathways
Overview: Properties of Afferent Neurons.
Pathways to the Spinal Cord.
Functional Properties of Bladder Afferents.
Modulators of Afferent Sensitivity.
Nitric Oxide.
Purinergic Signaling.
Transient Receptor Potential Cation Channels.
Cannabinoids.
Opioid Peptides.
Pelvic Organ Interactions: Crosstalk Between Bladder and Bowel.
Efferent Pathways to the Bladder
Terminal Nerve Fibers.
Spinal Ascending and Descending Influences: Transmitters
Glutamate.
Glycine and γ-Aminobutyric Acid.
Serotonin.
Adrenergic Transmitters.
Purinergic Transmitters.
Reflex Circuitry Controlling Continence and Micturition.
Storage Phase of the Bladder.
Sphincter to Bladder Reflexes.
Somatic to Visceral Reflexes.
Emptying Phase of the Bladder.
Urethra to Bladder Reflexes.
Supraspinal Pathways
Pontine Micturition Center and Brainstem Modulatory Mechanisms.
Central Circuitry Regulating Bladder Function by Transneuronal Tracing.
Neurotransmitters and Modulators Within Brainstem Networks.
Human Brain Imaging Studies.
Cerebral Control of Voiding.
Additional Regions.
Model of Brain-Bladder Control and Normal Continence Mechanism.
Pharmacology
Muscarinic Mechanisms
Muscarinic Selectivity
Cognitive Impairment With Antimuscarinic Agents
Adrenergic Mechanisms
β-Adrenergic Receptors
α-Adrenergic Receptors
Urethral Tone in Women
Afferent Neuropeptides
Tachykinins
Prostanoids
Endothelins
Sex Steroids
Clinical Relevance
Mechanisms of Idiopathic Detrusor Overactivity and Overactive Bladder
Stress Urinary Incontinence
Spinal Cord Injury and Neurogenic Detrusor Overactivity
Nocturia
Bladder Outlet Obstruction
Underactive Bladder
Bladder Pain Syndrome and Interstitial Cystitis
Aging
Neuromodulation
Hypothesis of Mechanism of Action of Sacral Neuromodulation
Rationale for Neuromodulation to Facilitate Voiding
Rationale for Neuromodulation to Inhibit the Overactive Bladder
Pudendal Nerve Stimulation
Inhibitory and Excitatory Stimulation Frequencies of the Pudendal-Bladder Reflexes
Activation of Somatic Afferents in the Foot
OnabotulinumtoxinA Neuromodulation
Future Research
References
Chapter 111: Pathophysiology and Classification of Lower Urinary Tract Dysfunction: Overview
Normal Lower Urinary Tract Function: Overview
Two-Phase Concept of Function: Filling/Storage and Emptying/Voiding
Mechanisms Underlying the Two Phases of Function: Overview
Bladder Response During Filling
Outlet Response During Filling
Voiding With a Normal Bladder Contraction
Urinary Continence During Abdominal Pressure Increases
Sensory Aspects
Micturition Cycle: Simplification and Overview
Filling/Storage
Emptying/Voiding
Abnormalities of Filling/Storage and Emptying/Voiding: Overview of Pathophysiology
Filling and Storage Failure
Bladder Overactivity
Filling and Storage Failure Resulting From Altered Sensation
Outlet Underactivity
Emptying and Voiding Failure
Bladder Underactivity
Outlet Overactivity or Obstruction
Classification Systems
Functional System
Urodynamic Classification
Lapides Classification
Hald-Bradley Classification
Bradley Classification
Suggested Readings
References
Chapter 112: Evaluation and Management of Women With Urinary Incontinence and Pelvic Prolapse
Definition and Impact of Pelvic Floor Disorders
Introduction
Diagnostic Evaluation
General Considerations
History
History of Present Illness
Past Medical and Surgical History
Medications
Other
Physical Examination
Supplemental Evaluation
Symptom Quantification Instruments
Voiding Diaries
Questionnaires and Quality of Life Instruments
Pad Tests
Dye Testing
Urinalysis
Postvoid Residual
Cystoscopy
Urodynamics
Radiographic Imaging
Voiding Cystourethrogram
Ultrasonography
Magnetic Resonance Imaging
Management
Incontinence Treatment Overview
Pelvic Prolapse Treatment Overview
Conclusion
Suggested Readings
References
Chapter 113: Evaluation and Management of Men With Urinary Incontinence
Types of Urinary Incontinence
Stress Urinary Incontinence
Urgency Urinary Incontinence
Mixed Urinary Incontinence
Nocturnal Enuresis
Continuous Urinary Incontinence
Incontinence Associated With Chronic Retention
Other Types of Urinary Incontinence
Evaluation
History
Physical Examination
First-Line Investigations
Measurement of Height and Weight to Calculate Body Mass Index
Urinalysis
Bladder Diary
Quality-of-Life Questionnaires and Patient-Reported Outcome Measures
Pad Testing
Urine Flow Rate and Postvoid Residual
Measurement of Prostate-Specific Antigen
Blood Tests
Advanced Investigations
Imaging.
Endoscopy.
Urodynamic Studies.
Principal Methods of Treating Men With Urinary Incontinence
Management of Different Urinary Incontinence Types in Men
Treatment of Urgency Urinary Incontinence
Treatment of Stress Urinary Incontinence
Treatment of Mixed Urinary Incontinence
Treatment of Other Types of Urinary Incontinence
Enuresis
Post-Micturition Dribble
Algorithms for Management of Men With Urinary Incontinence
Conclusion
Suggested Readings
References
Chapter 114: Urodynamic and Video-Urodynamic Evaluation of the Lower Urinary Tract
Role of Urodynamics in Clinical Practice
Conducting a Urodynamic Study: Patient and Technical Factors
Functional Classification of Voiding Dysfunction
Preparing for Urodynamic Studies: Clinician, Patient, and Facility
Defining the Clinical Question
Patient Preparation
Facility Setup
Additional Factors
Components of the Urodynamic Study
Urodynamic Equipment
Urodynamic Systems
Signal Transmission and Transducers
Uroflowmeters
Electromyography
The Urodynamic Study: Analysis and Interpetation
Filling and Storage Phase
Normal Filling and Storage
Abnormalities of Bladder Filling: Detrusor Overactivity and Impaired Compliance
Leak Point Pressures
Stress-Induced Detrusor Overactivity
Occult Stress Incontinence
Urethral Pressure Profilometry
Voiding and Emptying Phase
Normal Voiding and Emptying
Voiding Pressure-Flow Studies
Bladder Outlet Obstruction and Detrusor Underactivity in Men
Bladder Outlet Obstruction in Women
Sphincter Coordination
The External Sphincter
The Internal Sphincter
Videourodynamics
Ambulatory Urodynamics
Clinical Utility of Ambulatory Urodynamics
Clinical Applications of Urodynamic Studies: Evidence-Based Review and Guidelines Pertaining to Urodynamics
Guidelines
Evaluation of Women With Stress Incontinence
Evaluation of Men and Women With Lower Urinary Tract Symptoms
Evaluation of Neurogenic Lower Urinary Tract Dysfunction
Future Directions
References
Chapter 115: Urinary Incontinence and Pelvic Prolapse: Epidemiology and Pathophysiology
Definition and Classification of Urinary Incontinence
Introduction and Overview of the Lower Urinary Tract
Signs, Symptoms, and Urodynamic Observations of Urinary Incontinence
Terminology of Lower Urinary Tract Symptoms and Incontinence
Incontinence
Bladder Storage and Sensation
Epidemiology of Urinary Incontinence in Women
General Comments
Risk Factors for Urinary Incontinence in Women
Aging
Pregnancy
Aspects of Delivery
Parity
Race and Ethnicity
Hormonal Therapy
Obesity
Smoking
Diet
Medical Conditions
Epidemiology of Urinary Incontinence in Men
Prevalence, Incidence, Remission Rates
Risk Factors for Urinary Incontinence in Men
Definitions and Classification of Pelvic Organ Prolapse
Symptoms of Pelvic Organ Prolapse
Physical Examination of Pelvic Organ Prolapse
Epidemiology of Pelvic Organ Prolapse
Risk Factors for Pelvic Organ Prolapse
Relationship Between Urinary Incontinence and Pelvic Organ Prolapse
Consequences of Urinary Incontinence and Prolapse
Societal Costs of Urinary Incontinence
Social Impact of Urinary Incontinence
Impact of Pelvic Organ Prolapse on Quality of Life
Financial Impact of Pelvic Organ Prolapse
Physiology of Urinary Continence
Overview of Normal Continence Mechanisms
Neural Control of the Lower Urinary Tract
Bladder: an Organ Capable of Significant Expansion at Low Pressures
Bladder Outlet and Sphincteric Mechanisms
Male Sphincteric Mechanisms
Female Sphincteric Mechanisms
Pathophysiology of Urinary Incontinence: General Principles
Factors Affecting Bladder Storage
Factors Affecting Sphincteric Function
Pathophysiology of Stress Urinary Incontinence in Women
Loss of Urethral Support
Intrinsic Sphincteric Deficiency
Pathophysiology of Insensible Incontinence
Pelvic Floor Support Mechanism
Pathophysiology of Pelvic Organ Prolapse
Suggested Readings
References
Chapter 116: Neuromuscular Dysfunction of the Lower Urinary Tract
Objectives
Patterns of Neuropathic Voiding Dysfunction
Neuroplasticity
Diseases at or Above the Brainstem
Cerebrovascular Disease
Cerebrovascular Accident (Stroke)
Brainstem Stroke
Dementia
Traumatic Brain Injury
Brain Tumor
Cerebellar Ataxia
Normal-Pressure Hydrocephalus
Cerebral Palsy
Parkinson Disease
Multiple System Atrophy
Progressive Supranuclear Palsy
Diseases Primarily Involving the Spinal Cord
Multiple Sclerosis
Spinal Cord Injury
Epidemiology, Morbidity, General Concepts
Spinal Shock
Suprasacral Spinal Cord Injury
Sacral Spinal Cord Injury
Neurologic and Urodynamic Correlation
Autonomic Dysreflexia
Vesicoureteral Reflux
Urinary Tract Infection
Spinal Cord Injury in Women
Spinal Cord Injury (Neurogenic Bladder) and Bladder Cancer
Follow-Up
Cervical Myelopathy
Acute Transverse Myelitis
Neurospinal Dysraphism
Tabes Dorsalis, Pernicious Anemia
Subacute Combined Degeneration
Poliomyelitis
Disease Distal to the Spinal Cord
Disk Disease
Spinal Stenosis
Radical Pelvic Surgery
Simple and Radical Hysterectomy
Childbirth
Herpesvirus Infections
Diabetes Mellitus
Guillain-Barré Syndrome
Miscellaneous Neurologic Diseases Causing Lower Urinary Tract Dysfunction
Amyotrophic Lateral Sclerosis
Lyme Disease
Hereditary Spastic Paraplegia
Tropical Spastic Paraparesis
Acquired Immunodeficiency Syndrome
Acute Disseminated Encephalomyelitis
Syringomyelia
Schistosomal Myelopathy
Systemic Lupus Erythematosus
Reflex Sympathetic Dystrophy
Tuberculosis
Miscellaneous Conditions Definitely, Probably, or Possibly Related to Neuromuscular Dysfunction
Detrusor Sphincter Dyssynergia
Dysfunctional Voiding
Bladder Neck Dysfunction
Bladder Outlet Obstruction in Women
Low-Pressure and Low-Flow Voiding in Younger Men: Paruresis (Bashful Bladder)
Urinary Retention: Fowler Syndrome in Young Women
Postoperative Urinary Retention
Hyperthyroidism
Schizophrenia
Gastroparesis
Myasthenia Gravis
Isaacs Syndrome
Wernicke Encephalopathy
Systemic Sclerosis (Scleroderma)
Ehlers-Danlos Syndrome
Myotonic Dystrophy
Corticobasal Degeneration
Sacrococcygeal Teratoma
Williams-Beuren Syndrome
Amyloidosis
Machado-Joseph Disease
Radiation
Defunctionalized Bladder
Disorders of Sexual Differentiation
Aging
Benign Joint Hypermobility Syndrome
Attention-Deficit/Hyperactivity Disorder
Other Conditions
Treatment of Neurogenic Lower Urinary Tract Dysfunction: Overview
Suggested Readings
References
Chapter 117: Overactive Bladder
Terminology and Definitions
Mixed Symptoms Incorporating Urinary Urgency
Distinguishing Overactive Bladder From Bladder Pain Syndrome
Epidemiology and Economics
Prevalence of Overactive Bladder and Related Lower Urinary Tract Symptoms
Incidence and Progression of Overactive Bladder
Health Burden of Overactive Bladder
Pathophysiology and Etiology
Afferent Mechanisms in Overactive Bladder
Mechanisms of Increased Afferent Activity
Other Mechanisms of Increased Afferent Signaling.
Abnormal Handling of Afferent Signals.
Other Pathophysiologic Mechanisms
Etiology and Attributable Risk Factors
Clinical Assessment
Initial Evaluation
History
Physical Examination
Laboratory Examination
Advanced Evaluation
Management
First-Line Therapy
Second-Line Therapy
Third-Line Therapy
Fourth-Line Therapy
Approach
Suggested Readings
References
Chapter 118: The Underactive Detrusor
Terminology, Definitions, and Symptoms
Epidemiology
Etiopathogenesis
Myogenic Factors
Neurogenic Factors
Brain Circuits
Bladder Efferent Pathways
Bladder and Urethral Afferent Pathways
Specific Etiologic Factors
Bladder Outlet Obstruction
Diabetes Mellitus
Neurologic Disease or Injury
Pelvic Arterial Ischemia
Diagnosis
Detrusor Contraction Strength
Detrusor Contraction Speed
Detrusor Contraction Duration
Bladder Sensation
Ambulatory Urodynamics
Management
Initial Assessment
Conservative Management
Pharmacotherapies
Parasympathomimetics for Underactive Bladder
α-Adrenoreceptor Antagonists
Prostanoids
Future Prospects in Pharmacotherapy
Electrical Stimulation
Botulinum Toxin
Surgery
Bladder Outlet Surgery
Urinary Diversion
Reconstructive Surgery
Regenerative Medicine
Conclusions
Suggested Readings
References
Chapter 119: Nocturia
Rationale for Evaluation and Management
Nocturia Is Bothersome
Nocturia Is Common
Association of Nocturia With Early Mortality
Costs to Society
Evaluation
Cause and Management
Nocturnal Polyuria
Epidemiology and Causes
Management
Diminished Global and Nocturnal Bladder Capacity
Causes
Management
Mixed Nocturnal Polyuria and Diminished Global and Nocturnal Bladder Capacity
Polyuria
Etiology
Management
Suggested Readings
References
Chapter 120: Pharmacologic Management of Lower Urinary Tract Storage and Emptying Failure
Introduction
Pharmacologic Therapy to Facilitate Bladder Filling and Urine Storage
Inhibiting Bladder Contractility, Decreasing Sensory Input, Increasing Bladder Capacity
Bladder Contraction
Muscarinic Receptors
Prevalence of Lower Urinary Tract Symptoms
Antimuscarinic (Anticholinergic) Agents
Mechanism of Action.
Pharmacologic Properties.
Clinical Use.
Adverse Effects.
Antimuscarinics With “Pure” Action
Atropine Sulfate.
Darifenacin Hydrobromide.
Assessment.
Fesoterodine Fumarate.
Assessment.
Imidafenacin.
Assessment.
Propantheline Bromide.
Assessment.
Solifenacin Succinate.
Assessment.
Tolterodine Tartrate.
Assessment.
Trospium Chloride.
Assessment.
Antimuscarinics With “Mixed” Action
Oxybutynin Chloride.
Immediate-Release Oxybutynin.
Extended-Release Oxybutynin.
Transdermal Oxybutynin.
Oxybutynin Topical Gel.
Other Administration Forms.
Effects on Cognition.
Assessment.
Propiverine Hydrochloride.
Assessment.
Flavoxate Hydrochloride.
Assessment.
Drugs Acting on Membrane Channels
Calcium Antagonists.
Potassium Channel Openers.
α-Adrenoceptor Antagonists
β-Adrenoceptor Agonists
Background.
Clinical Use.
Mirabegron
Pharmacokinetics.
Efficacy.
Tolerability and Adverse Effects.
New Developments
Phosphodiesterase Inhibitors
Antidepressants
Imipramine.
Doxepin.
Milnacipran Hydrochloride and Paroxetine Hydrochloride.
Duloxetine.
Side Effects and Cardiovascular Risks.
Cyclooxygenase Inhibitors
Other Drugs
Dimethyl Sulfoxide.
Baclofen.
Combinations
α1A-AR Antagonists With Antimuscarinics.
β3-AR Agonist With Antimuscarinics.
β3-AR Agonist With α1A-AR Antagonists.
Combined Antimuscarinics.
Antimuscarinics and 5α-Reductase Inhibitors.
α1-AR Antagonists With 5α-Reductase Inhibitors.
Toxins
Botulinum Toxin
Mechanism of Action.
Clinical Use.
Efficacy.
Adverse Effects.
Capsaicin and Resiniferatoxin (Vanilloids).
Rationale for Intravesical Vanilloids.
Intravesical Capsaicin.
Resiniferatoxin in Neurogenic Detrusor Overactivity.
Resiniferatoxin in Idiopathic Detrusor Overactivity.
Resiniferatoxin and Urgency.
Estrogens for Urgency Urinary Incontinence and Overactive Bladder Symptoms
Evidence Regarding Estrogens and Incontinence From Large Clinical Trials.
Other Hormones and Desmopressin
Desmopressin.
Drug Treatment of Overactivity in Augmented or Intestinal Neobladders
Future Possibilities
Peripherally Acting Drugs
Vitamin D3-Receptor Analogues.
Transient Receptor Potential Channel Antagonists.
Prostanoid-Receptor Agonists and Antagonists.
Intraprostatically Injected Drugs
NX-1207.
PRX302.
Cannabinoids.
Centrally Acting Drugs.
Gonadotropin-Releasing Hormone Antagonists.
Gabapentin.
Tramadol.
NK1-Receptor Antagonists.
Increasing Outlet Resistance
Drugs Used for Treatment of Stress Incontinence in Women
Estrogens
Estrogens and the Continence Mechanism.
Estrogens for Stress Urinary Incontinence.
α-AR Agonists.
β-AR Agonists
Clenbuterol.
β-AR Antagonists.
Serotonin-Noradrenaline Uptake Inhibitors
Imipramine.
Duloxetine.
Drugs Used for Treatment of Stress Urinary Incontinence in Men
Pharmacologic Therapy to Facilitate Bladder Emptying
Increasing Intravesical Pressure and Bladder Contractility
Parasympathomimetic Agents
Prostaglandins
Blockers of Inhibition
Opioid-Receptor Antagonists
Decreasing Outlet Resistance
At a Site of Anatomic Obstruction
At the Level of the Smooth Sphincter
α-Adrenoceptor Antagonists.
Phenoxybenzamine.
Prazosin.
Terazosin and Doxazosin.
Alfuzosin and Tamsulosin.
Silodosin.
Nitric Oxide.
At the Level of the Striated Sphincter
Benzodiazepines.
Baclofen.
Dantrolene.
Botulinum Toxin.
Suggested Readings
References
Chapter 121: Conservative Management of Urinary Incontinence: Behavioral and Pelvic Floor Therapy, Urethral and Pelvic Devices
Indications
Assessment Before Behavioral Treatments
Patient Education
Pelvic Floor Muscle Training
Assessment of Pelvic Floor Muscle Function
Teaching Pelvic Floor Muscle Control
Pelvic Floor Muscle Exercise Regimens
Use of Pelvic Floor Muscle Contraction to Prevent Stress Incontinence
Evidence for Pelvic Floor Muscle Training
Antenatal Urinary Incontinence
Postpartum Urinary Incontinence
Post-Prostatectomy Urinary Incontinence
Vaginal Cones for Pelvic Floor Muscle Training
Other Pelvic Floor Muscle Training Devices
Behavioral Training With Urge Suppression
Role of Biofeedback
Pelvic Floor Muscle Electrical Stimulation
Bladder Training and Scheduled Voiding Regimens
Bladder Training
Evidence for Bladder Training
Other Scheduled Voiding Regimens
Timed Voiding
Habit Training
Prompted Voiding
Challenges of Caregiver-Administered Voiding Schedules.
Delayed Voiding
Behavioral Treatment for Voiding and Pelvic Floor Dysfunction
Lifestyle Modifications
Fluid Management
Excessive Fluid Intake.
Inadequate Fluid Intake.
Timing of Fluid Intake.
Evidence for Fluid Management.
Caffeine Reduction
Other Dietary Irritants
Bowel Function
Obesity and Weight Reduction
Adherence to Conservative Treatment
Prevention of Urinary Incontinence
Older Women
Childbearing Women
Men Undergoing Prostatectomy
Future of Lower Urinary Tract Symptom Prevention and Bladder Health Promotion Research
Vaginal and Urethral Mechanical Devices for Incontinence
Intravaginal Devices
Models of Delivery
Suggested Readings
References
Chapter 122: Electrical Stimulation and Neuromodulation in Storage and Emptying Failure
History of Electrical Stimulation
Neurophysiology Relevant to Electrical Stimulation for Storage and Voiding Disorders
Sacral Anterior Root Stimulation and Sacral Dorsal Rhizotomy
Stimulator
Technique of Post-Stimulus Voiding
Goal and Effect of Dorsal Rhizotomy of the Sacral Nerves
Patient Selection
Surgical Implantation Technique
Clinical Results
Current and Future Perspectives for Neurostimulation
Working Mechanism of Electrical Stimulation in Non-Neurogenic Storage and Voiding Disorders
Techniques of Electrostimulation of the Lower Urinary Tract
Intravesical Stimulation
Transcutaneous Electrostimulation
Transcutaneous Tibial Nerve Stimulation
Transcutaneous Sacral Dermatome Stimulation
Percutaneous Tibial Nerve Stimulation
History of Percutaneous Tibial Nerve Stimulation
Technique of Percutaneous Tibial Nerve Stimulation
Clinical Results of Percutaneous Tibial Nerve Stimulation
Percutaneous Tibial Nerve Stimulation Compared With Other Treatments
Prognostic Factors for Percutaneous Tibial Nerve Stimulation
Implantable Percutaneous Tibial Nerve Stimulation
Conclusions
Pudendal Nerve Stimulation
Dorsal Genital Nerve Stimulation
Sacral Nerve Stimulation
Current Indications and Outcomes for Sacral Neuromodulation
Overactive Bladder With or Without Urinary Incontinence
Nonobstructive Chronic Underactive Bladder (Voiding Dysfunction)
Other Indications
Sacral Neuromodulation Patient Selection and Implantation Procedure
Percutaneous Nerve Evaluation Test.
Staged Implant Procedure.
Future Perspectives of Sacral Neuromodulation
Constant Versus Intermittent Stimulation
Rechargeable Neurostimulator
Other Issues
Suggested Readings
References
Chapter 123: Retropubic Suspension Surgery for Incontinence in Women
Therapeutic Options
Choice of Surgical Technique
Differentiating Relative Contributions of Hypermobility and Intrinsic Sphincter Deficiency
Surgical Procedures
Degree of Urethral Elevation
Configuration of the Suspensions
Tissue Approximation
Assessing Outcomes of Therapy
Duration of Follow-Up
Issue of Intrinsic Sphincter Deficiency
Definition of Cure
Patient’s Versus the Physician’s Perspective
Indications for Retropubic Repair
Specific Indications
Potential Contraindications
Vaginal Versus Retropubic Surgery
General Technical Issues
Retropubic Dissection
Suture Material
Bladder Drainage
Drains
Marshall-Marchetti-Krantz Procedure
Technique
Results
Burch Colposuspension
Technique
Results
Prophylactic Colposuspension
Reoperative Surgery
Paravaginal Repair
Technique
Results
Vagino-Obturator Shelf Repair
Technique
Results
Laparoscopic Retropubic Suspension
Complications of Retropubic Repairs
Postoperative Voiding Difficulty
Bladder Overactivity
Vaginal Prolapse
Comparisons of Incontinence Procedures
Retropubic Repair Versus Needle Suspension and Anterior Repair
Retropubic Repair Versus Pubovaginal Sling
Burch Colposuspension Versus Marshall-Marchetti-Krantz Procedure Versus Paravaginal Repair
Tension-Free Vaginal Tape Procedure Versus Colposuspension
World Without Mesh
Suggested Readings
References
Chapter 124: Vaginal and Abdominal Reconstructive Surgery for Pelvic Organ Prolapse
Preparing the Patient for Prolapse Surgery
Preoperative Counseling of Patient for Vaginal Pelvic Organ Prolapse Surgery
Use of Mesh in Vaginal Surgery: Current Controversy
Surgical Management of Pelvic Organ Prolapse
Anterior Compartment
Anterior Colporrhaphy
Anterior Colporrhaphy Technique (Fig. 124.2).
Anterior Colporrhaphy Repairs Results.
Anterior Colporrhaphy Complications.
Procedures for Lateral and Combined Defects
Vaginal Paravaginal Repair.
Technique (Fig. 124.3).
Vaginal Paravaginal Repair Results (See Table 124.3).
Anterior Compartment Repairs Using Grafts Technique
Anterior Polypropylene Mesh Results
Anterior Repair With Cadaveric Fascia Results
Anterior Repair With Porcine Dermis Results
Biologics Versus Mesh Results
Mesh-Related Complications
Other Procedures to Correct Anterior Compartment Defects
Abdominal Paravaginal Repair Technique (Fig. 124.8).
Abdominal Paravaginal Results (See Table 124.4).
Anterior Compartment Repair With Sling.
Apical Compartment
Apical Vaginal Vault Prolapse Repairs via Uterosacral Ligament Suspension
Surgical Anatomy of the Uterosacral Ligaments.
High Uterosacral Vaginal Vault Suspension Technique.
Abdominal Approach to the Uterosacral Ligaments.
Uterosacral Ligaments Results.
Sacrospinous Ligament Fixation
Surgical Anatomy of the Sacrospinous Ligament Fixation.
Sacrospinous Ligament Fixation Technique.
Sacrospinous Ligament Fixation Results (Table 124.6).
Sacrospinous Ligament Fixation Complications.
Iliococcygeus Suspension
Iliococcygeus Suspension Technique and Results.
Abdominal Sacrocolpopexy
Open Abdominal Sacrocolpopexy Technique.
Robotic-Assisted Laparoscopic Sacrocolpopexy Technique.
Laparoscopic Sacrocolpopexy Technique.
Sacrocolpopexy Complications.
Results of Sacrocolpopexy.
Abdominal Sacrocolpopexy Versus Laparoscopic Sacrocolpopexy (Table 124.9).
Laparoscopic Sacrocolpopexy Versus Robotic-Assisted Sacrocolpopexy Versus Abdominal Sacrocolpopexy (Table 124.10).
Laparoscopic Sacrocolpopexy Versus Robotic-Assisted Colpopexy.
Learning Curve.
Cost.
Comparison of Apical Procedures
Colpocleisis
Partial Colpocleisis—Technique.
Total Colpocleisis: Technique (Fig. 124.33).
Colpocleisis Results.
Partial Colpocleisis Results.
Uterine Prolapse
Vaginal Hysterectomy With McCall Culdoplasty Technique
Vaginal Hysterectomy Complications.
Uterine Sparing and Hysteropexy
Transvaginal Uterine-Sparing Techniques.
Manchester Procedure.
Manchester Procedure Complications.
Manchester Procedure Results.
Transvaginal Uterosacral Ligament Hysteropexy Technique.
Transvaginal Uterosacral Ligament Hysteropexy Complications.
Transvaginal Uterosacral Ligament Hysteropexy Results.
Sacrospinous Hysteropexy Technique.
Sacrospinous Hysteropexy Complications.
Sacrospinous Hysteropexy Results.
Minimally Invasive Uterosacral Hysteropexy Technique.
Minimally Invasive Uterosacral Hysteropexy Complications.
Minimally Invasive Uterosacral Hysteropexy Results.
Open Abdominal Sacrohysteropexy Technique.
Minimally Invasive Sacrohysteropexy Technique.
Minimally Invasive Sacrohysteropexy Complications.
Sacrohysteropexy Results.
Posterior Compartment Repair
Posterior Colporrhaphy Technique
Site Specific Repair: Technique.
Perineorrhaphy: Technique.
Posterior Colporrhaphy Results (Table 124.18).
Interposition Graft Repairs of the Posterior Compartment
References
Chapter 125: Slings: Autologous, Biologic, Synthetic, and Mid-urethral
The Evolution of Slings
Pathophysiology of Stress Urinary Incontinence and Sling Mechanism of Action
The Age of the Mid-Urethral Sling
Preoperative Assessment
Alternative Treatment Options
Pubovaginal Sling (PVS)
Anatomy and Mechanics of a Pubovaginal Sling
Pubovaginal Sling Materials
Autologous Pubovaginal Slings
Pubovaginal Sling Allograft Materials
Pubovaginal Sling Xenograft Materials
Pubovaginal Sling Synthetic Prosthetic Materials
Pubovaginal Sling Operative Procedure
Counseling
Anesthesia, Patient Positioning, and Preparation
Graft Harvest for Autologous Pubovaginal Sling
Pubovaginal Sling Vaginal Dissection
Pubovaginal Sling Placement and Fixation
Pubovaginal Sling Postoperative Care
Outcomes of Pubovaginal Slings for Predominantly Stress Urinary Incontinence
Autologous Pubovaginal Slings
Allograft Pubovaginal Slings
Synthetic Pubovaginal Slings
Xenograft Pubovaginal Slings
Outcomes of Autologous Pubovaginal Slings for Mixed Urinary Incontinence
Outcomes of Autologous Pubovaginal Slings for Urethral Reconstruction
Voiding Dysfunction Secondary to Bladder Outlet Obstruction After Pubovaginal Sling Surgery
Surgical Management of Voiding Dysfunction After Pubovaginal Sling Surgery
Complications of Pubovaginal Slings
Pubovaginal Sling Perforation and Exposure
Pubovaginal Sling Nonurologic Complications
Mid-Urethral Slings
Mechanics, Anatomy, and Materials of Mid-Urethral Slings
Mechanics of the Mid-Urethral Sling
Anatomy of the Retropubic Mid-Urethral Sling
Anatomy of the Transobturator Mid-Urethral Sling
Anatomy of the Single-Incision Mid-Urethral Slings
Mid-Urethral Sling Materials
Mid-Urethral Sling Operative Procedures
Mid-Urethral Sling Patient Counseling
Mid-Urethral Sling Anesthesia, Patient Positioning, and Preparation
Surgical Approach for Retropubic Mid-Urethral Slings
Surgical Approach for Transobturator Outside-in Slings
Surgical Approach for Transobturator Inside-Out Slings
Surgical Approach for Single-Incision Slings
Outcomes of Mid-Urethral Slings for Predominantly Stress Urinary Incontinence
Outcomes for Retropubic Mid-Urethral Slings in Patients With Predominantly Stress Urinary Incontinence
Outcomes for Transobturator Mid-Urethral Slings in Patients With Predominantly Stress Urinary Incontinence
Outcomes for Single-Incision Mid-Urethral Slings in Patients With Predominantly Stress Urinary Incontinence
Outcomes of Mid-Urethral Slings for Mixed Urinary Incontinence
Outcomes of Mid-Urethral Slings for Intrinsic Sphincteric Deficiency
Outcomes of Mid-Urethral Slings for Recurrent Stress Urinary Incontinence
Outcomes of Mid-Urethral Slings in Patients With Pelvic Organ Prolapse
Outcomes of Mid-Urethral Slings in Elderly Women
Outcomes of Mid-Urethral Slings in Obese Patients
Complications of Retropubic, Transobturator, and Single-Incision Mid-Urethral Slings
Mid-Urethral Sling Mesh Exposure
Management of Mid-Urethral Sling Mesh Exposure
Mid-Urethral Sling Trocar Injury to the Urinary Tract
Urethral Perforation During Mid-Urethral Sling Mesh Placement
Management of Mid-Urethral Sling Mesh Perforation of the Urethra
Mid-Urethral Sling Mesh Perforation of the Bladder
Management of Mid-Urethral Sling Mesh Perforation of the Bladder
Infection and Pain After Mid-Urethral Sling Surgery
Management of Severe Infection or Pain After Mid-Urethral Sling
Voiding Dysfunction After Mid-Urethral Sling Surgery
Management of Voiding Dysfunction After Mid-Urethral Sling Surgery
Sexual Dysfunction After Mid-Urethral Sling Surgery
Other Complications After Mid-Urethral Sling Surgery
Management of Recurrent or Persistent Stress Urinary Incontinence After Mid-Urethral Sling Surgery
Regulatory and Legal Issues Related to Sling Mesh Complications
Suggested Readings
References
Chapter 126: Complications Related to the Use of Mesh and Their Repair
Mesh and Its Properties
Mesh Slings for Stress Urinary Incontinence
Risk Factors for Mesh Sling Complications
Mesh Complications Among the Three Slings
Bladder Outlet Obstruction and New Urgency and Urgency Incontinence
Vaginal Mesh Exposure and Extrusion
Vaginal, Pelvic, and Thigh Pain
Groin Pain
Complications of Vaginal Mesh Removal
Bladder Injury and Perforation/Extrusion
Mesh Perforation/Extrusion at Bladder Neck or Urethra
Transvaginal (Anterior and Posterior Wall) Mesh Complications
Treatment of Prolapse Mesh Complications
Surgical Mesh Removal
Apical Mesh Complications
Treatment of Mesh Exposure
Male Mesh Slings
References
Chapter 127: Additional Therapies for Storage and Emptying Failure
Additional Therapies for Storage Failure at the Bladder Level
Augmentation Cystoplasty
Historical Perspective
Indications for Augmentation Cystoplasty
Bladder Compliance.
Capacity.
Detrusor Overactivity.
Augmentation Cystoplasty Techniques
Contraindications to Augmentation Cystoplasty
Additional Therapies for Storage Failure at the Bladder Outlet
Urethral Bulking Agents
Use of Injectable Agents for Female Stress Urinary Incontinence
Patient Selection, Indications, and Contraindications
Injection Techniques
Periurethral Technique.
Transurethral Techniques.
Periprocedure Care
Efficacy of Urethral Injection Therapy for Female Stress Urinary Incontinence
Adverse Events
Summary of Specific Agents
Glutaraldehyde Cross-Linked (GAX) Bovine Collagen (Contigen).
Carbon-Coated Zirconium Beads (Durasphere).
Silicone Microimplants (Macroplastique).
Calcium Hydroxylapatite (Coaptite).
Agents Available Outside the United States.
Adjustable Continence Therapy
Outcomes
Complications
Cell-Based Therapy
Human Studies
Use of Injectable Agents for Male Stress Urinary Incontinence
Injection Techniques
Retrograde Injection.
Antegrade Injection.
Collagen.
Silicone Microimplants (Macroplastique).
Cell-Based Therapy.
Use of Injectable Agents After Urinary Diversion
Bladder Outlet Closure: Functional and Complete
Additional Therapies for Emptying
Continent Catheterizable Channels
Catheterization
Clean Intermittent Catheterization
Continuous Catheterization
Increasing Intravesical Pressure or Facilitating Bladder Contractility
External Compression (Credé) and Valsalva Maneuver
Promotion or Initiation of Reflex Contractions
Intraurethral Valve-Pump for Women With Impaired Detrusor Contractility
Stimulated Myoplasty for Bladder Emptying
Additional Therapies for Storage and Emptying Failure: Circumventing the Problem
External Collecting Devices
Absorbent Products
Summary
Suggested Readings
References
Chapter 128: Aging and Geriatric Urology
Biology and Principles of Aging
Physiologic Aging
Aging and the Lower Urinary System
Demographics of Aging
Aging and Population Trends
Global Implications for Urologic Health Care
Clinical Evaluation of the Geriatric Urology Patient
Functional Assessment
Activities of Daily Living
Instrumental Activities of Daily Living
Mobility
Cognition
Depression
Surgical Risk and Medical Optimization
Anesthesia
Prehabilitation
Comprehensive Geriatric Assessment
Major Geriatric Syndromes and Urology
Frailty
Delirium
Falls
Pressure Ulcers
Polypharmacy and Medication Optimization
Urinary Incontinence
Geriatric Specific Risk Factors for Urinary Incontinence
Costs of Incontinence
Negative Impacts of Urinary Incontinence
Established Versus Transient Incontinence
Established Urinary Incontinence.
Transient Versus Established Urinary Incontinence.
Transient Urinary Incontinence.
Types of Established Urinary Incontinence.
Incontinence in the Nursing Home Setting
Clinical Evaluation of Incontinence.
History.
Physical Examination.
Assessment of Postvoid Residual Volume.
Voiding Diaries.
Laboratory Testing.
Urodynamics.
Treatment of Incontinence.
Behavioral Therapies.
Pharmacotherapies.
Surgical Therapies.
Urine Containment and Absorbent Products.
Other Lower Urinary Tract Dysfunction, Urinary Tract Infections, Pelvic Floor Conditions, and Genitourinary Trauma
Bladder Outlet Obstruction
Underactive Bladder, Neurogenic Bladder, and Urinary Retention
Nocturia
Bowel Dysfunction and Fecal Incontinence
Continence Promotion and Advocacy
Pelvic Organ Prolapse
Urinary Tract Infections and Asymptomatic Bacteriuria
Hematuria
Genitourinary Trauma
Genitourinary Malignancies
Prostate Cancer
Bladder Cancer
Kidney Cancer
Testis Cancer
Urologic Cancers and Other Health Issues in Older Adults
Sexual Health in Elderly Women and Men
Discharge Planning and Care Coordination
Elder Mistreatment
End-of-Life Care and Urology
Summary
Suggested Readings
References
Chapter 129: Urinary Tract Fistulae
General Considerations
Prevention of Fistula
Preparation and Optimization of Patient
Medicolegal Aspects
Vesicovaginal Fistulae
Etiology and Prevalence
Obstetric Fistulae
Iatrogenic Fistulae
Intraoperative Risk Factors for Iatrogenic Vesicovaginal Fistulae
Evaluation and Diagnosis
Presentation
Physical Examination
Cystoscopy
Imaging
Other Studies
Classification of Fistulae
Treatment
Conservative and Minimally Invasive Therapy
Surgical Repair
Timing: Immediate Versus Delayed Repair
Approach: Abdominal Versus Vaginal
Handling of Fistula Tract: Excision Versus No Excision
Use of Adjuvant Flaps or Grafts: Type and Application
Other Considerations
Preoperative Counseling and Indications for Surgery
Vaginal Techniques
Vaginal Flap or Flap-Splitting Technique.
Complications.
Other Transvaginal Techniques.
Abdominal Techniques
Suprapubic Intraperitoneal or Extraperitoneal Approach.
Transvesical.
Laparoscopic and Robotic Approaches
Adjuvant Procedures in the Repair of Vesicovaginal Fistulae: Tissue Interposition
Martius Flap.
Peritoneal Flap.
Greater Omentum.
Other Flap and Graft Techniques.
Vesicovaginal Fistulae and Urinary Diversion.
Outcomes of Vesicovaginal Fistula Repair
Ureteric Fistulae
Etiology and Presentation
Diagnosis and Management
Vesicouterine Fistulae
Etiology and Presentation
Diagnosis and Management
Urethrovaginal Fistulae
Etiology and Presentation
Diagnosis
Treatment of Urethrovaginal Fistulae
Vaginal Approach
Labial and Vaginal Flaps and Neourethra
Martius Flap.
Rectus Muscle Flap.
Other Interposition Material.
Posterior Approach
Abdominal Approach
Complications
Follow-Up
Operative Technique
Uroenteric Fistulae
Etiology and Presentation
Pyeloenteric Fistulae
Diagnosis
Management
Rectourethral Fistulae
Etiology and Presentation
Management
Urovascular Fistulae
Renovascular and Pyelovascular Fistulae
Ureterovascular Fistulae
Oncologic and Radiation Fistulae
Cancer Surgery
Radiation Fistulae
Management of Radiation Fistulae: Diversion Procedures
Management of Radiation Fistulae: Repair Techniques
Other Management Approaches
Recommendations
Chemotherapy
Combination Therapies
Other Urinary Fistulae
Urinary Leak After Renal Preservation Surgery
Urinary Leak After Renal Transplantation
Acknowledgments
Suggested Readings
References
Chapter 130: Bladder and Female Urethral Diverticula
Bladder Diverticula
Classification, Pathophysiology, and Etiology
Diagnosis
Presentation and Evaluation
Imaging
Urodynamics
Endoscopic Examination
Associated Conditions
Bladder Outlet Obstruction
Malignancy
Other Associated Conditions
Management
Observation and Nonsurgical Management
Indications for Intervention
Endoscopic Management
Operative Excision
Female Urethral Diverticula
Anatomy of the Female Urethra
Urethral Diverticula
Pathophysiology and Etiology
Prevalence
Diverticular Anatomy and Histology
Presentation
Evaluation and Diagnosis
History and Physical Examination
Urine Studies
Cystourethroscopy
Urodynamics
Imaging
Diagnostic Contrast Radiography
Ultrasonography.
Magnetic Resonance Imaging.
Differential Diagnosis: Periurethral Masses Other Than Urethral Diverticula
Vaginal Leiomyoma.
Skene Gland Abnormalities.
Gartner Duct Abnormalities.
Vaginal Wall Cysts.
Urethral Mucosal Prolapse.
Urethral Caruncle.
Periurethral Bulking Agents.
Classification of Urethral Diverticula
Surgical Repair of Female Urethral Diverticula
Indications for Repair
Urethral Diverticula and Stress Urinary Incontinence
Techniques for Repair
Alternative Techniques.
Excision and Reconstruction.
Preoperative Preparation.
Procedure.
Postoperative Care.
Complications.
Persistence or Recurrence of Symptoms After Urethral Diverticulectomy.
Suggested Readings
Bladder Diverticula
Urethral Diverticula
References
Chapter 131: Surgical Procedures for Sphincteric Incontinence in the Male
Classification, Pathophysiology, and Etiology
History and Development of Devices
Innovations and Emerging Concepts in Device Design
Mechanisms of Continence With Surgical Devices
Evaluation and Diagnosis
History
Patient-Reported Measures
Physical Examination
Laboratory
Cystoscopy
Urodynamics
Evaluation of Persistent Incontinence After Artificial Urinary Sphincter and Sling
Indications for Surgery
Technique of Device Implantation
Operative Preparation
Artificial Urinary Sphincter
Pressure-Regulating Balloon
Control Pump Placement
Making the Connections
Tandem Cuff Artificial Urinary Sphincter
Transcorporal Artificial Urinary Sphincter Cuff
Trans-Scrotal Artificial Urinary Sphincter
Bladder Neck Artificial Urinary Sphincter
Transobturator Bulbourethral Sling
Four-Arm Sling
Artificial Urinary Sphincter Complications
Urinary Retention
Artificial Urinary Sphincter Infection
Urethral Erosion
Urethral Atrophy
Mechanical Failure
Special Circumstances
Sling Complications
Long-Term Results of Artificial Urinary Sphincters and Slings
Future Directions
Improving the Quality of Evidence
Training Paradigms
Summary
Acknowledgment
Suggested Readings
References
Part XIV: Benign and Malignant Bladder Disorders
Chapter 132: Bladder Surgery for Benign Disease
Bladder Anatomy and Surgical Considerations
Bladder Diverticulectomy
Description
Evaluation and Surgical Indications
Surgical Technique
Open Technique
Intravesical Approach.
Combined Intra-Extravesical Approach.
Laparoscopic and Robotic Techniques
Postoperative Care and Complications
Outcomes
Ureteral Reimplantation
Description
Evaluation and Surgical Indications
Surgical Technique
Open Technique
Ureteral Mobilization.
Bladder Mobilization.
Nonrefluxing Ureteral Reimplantation—Extravesical Approach (Modified Lich-Gregoir)
Nonrefluxing Ureteral Reimplantation—Transvesical Approach (Modified Politano-Leadbetter)
Refluxing Ureteral Reimplantation—Extravesical Approach
Refluxing Ureteral Reimplantation—Transvesical Approach
Laparoscopic and Robotic Techniques
Nonrefluxing Ureteral Reimplantation—Extravesical Approach (Modified Lich-Gregoir)
Refluxing Ureteral Reimplantation—Extravesical Approach
Postoperative Care and Complications
Outcomes
Psoas Hitch and Boari Flap
Description
Evaluation and Surgical Indication
Surgical Technique
Open Technique
Psoas Hitch.
Boari Flap.
Laparoscopic and Robotic Technique
Psoas Hitch.
Boari Flap.
Advancement Flap.
Laparoendoscopic Single-Site (LESS) Surgery Boari Flap.
Postoperative Care and Complications
Outcomes
Enterocystoplasty
Description
Evaluation and Surgical Indication
Surgical Technique
Open Technique
Laparoscopic and Robotic Techniques
Postoperative Care and Complications
Outcomes
Partial Cystectomy and Urachal Surgery
Description
Evaluation and Surgical Indications
Leiomyoma
Paraganglioma
Endometriosis
Urachal Abnormalities
Surgical Technique
Open
Extraperitoneal Approach to Partial Cystectomy
Transperitoneal Approach to Partial Cystectomy
Urachal Surgery
Laparoscopic and Robotic Techniques
Transperitoneal Approach to Partial Cystectomy
Urachal Surgery
Postoperative Care and Complications
Outcomes
Bladder Stones and Foreign-Body Removal
Description
Evaluation and Surgical Indication
Surgical Technique
Open
Laparoscopic and Robotic
Percutaneous
Postoperative Care and Complications
References
Bladder Diverticulectomy
Ureteral Reimplantation
Ureteral Reconstruction
Enterocystoplasty
Partial Cystectomy and Urachal Surgery
Bladder Stone and Foreign-Body Removal
Chapter 133: Genital and Lower Urinary Tract Trauma
Injuries of the External Genitalia
Penis
Fracture
Etiology.
Diagnosis and Imaging.
Management.
Outcome and Complications.
Gunshot and Penetrating Injuries
Gunshot Wounds.
Animal and Human Bites.
Penile Amputation.
Zipper Injuries.
Strangulation Injuries.
Testis
Etiology
Diagnosis
Management
Outcome and Complications
Genital Skin Loss
Etiology
Diagnosis and Initial Management
Penile Reconstruction
Scrotal Reconstruction
Bladder Injury
Etiology
Diagnosis and Radiographic Imaging
Clinical Signs and Symptoms
Management
Outcomes and Complications
Urethral Injury
Posterior Urethral Injuries
Etiology
Diagnosis
Examination.
Urethrography.
Initial Management
Initial Management: Suprapubic Cystostomy With Planned Delayed Reconstruction.
Initial Management: Primary Realignment.
Delayed Reconstruction
Preoperative Evaluation.
Endoscopic Treatment
Surgical Reconstruction
Complications: Erectile Dysfunction.
Complications: Recurrent Stenosis.
Complications: Incontinence.
Anterior Urethral Injuries
Etiology
Initial Management
Delayed Reconstruction
Suggested Readings
References
Injuries of the External Genitalia
Bladder Injuries and Urethral Injuries
Chapter 134: Special Urologic Considerations in Transgender Individuals
Urologic Issues in Gender Nonconforming Youths
Urologic Issues in Male-to-Female Transsexuals (Transwomen)
Effects of Sex Reassignment Surgery on Bladder Sphincter Function
Fate of the Prostate in Transwomen
Prostatitis
Benign Prostatic Hyperplasia
Prostate Cancer
Urologic Issues in Female-to-Male Transsexuals (Transmen)
Diagnosis and Preoperative Care
Diagnosis
Preoperative Care
Sex Reassignment Surgery
Removal of Female Anatomic Structures
Mastectomy, Hysterectomy, and Ovariectomy
Vaginectomy
Genitoperineal Transformation
Urethroplasty
The Phallic Urethra
Scrotoplasty
Phalloplasty
Metoidioplasty
Testicular Implants and Erectile Prosthesis
Postoperative Care, Follow-Up, and Urethral Complications
Early Postoperative Care
Transurethral Catheterization in Transmen
Urethral Complications in Transmen
Urethral Fistula
Urethral Stricture
Incidence.
Diagnosis.
Management.
Urethral Dilation
Endoscopic Incision (Direct Vision Internal Urethrotomy)
Urethral Reconstruction
Meatotomy
Heineke-Mikulicz Urethroplasty
Excision and Primary Anastomosis
Free Graft Urethroplasty
Two-Stage Urethroplasty
Flap Urethroplasty
Definitive Perineostomy
Urethral Hair Growth
Postvoid Dribbling
Conclusion
Suggested Readings
References
Chapter 135: Tumors of the Bladder
Epidemiology
Incidence, Prevalence, Mortality
Gender, Racial, and Age Differences
Economic Impact
Risk Factors
Genetics
Hereditary
Smoking
Body Mass Index
Occupational Risk
Medical Conditions
Schistosomiasis
Recurrent Infection
Indirect Medical Risk Factors
Pioglitazone
Radiation
Chemotherapy
Environmental Pollution
Diet
Fluids
Foods
Dietary Supplements
Detection of Urothelial Carcinoma
Cystoscopy
Urine Cytology
Fluorescence in Situ Hybridization
Bladder Tumor Antigen
Immunocyt
CxBladder
Pathology
Epithelial Metaplasia
Papilloma and Inverted Papilloma
Nephrogenic Adenoma
Leukoplakia
Cystitis Cystica and Glandularis
Precursor Malignant Lesions
Malignant Lesions
Staging
Molecular Biology
Histologic Variants of Urothelial Carcinoma
Micropapillary Variant
Sarcomatoid Variant
Plasmacytoid Variant
Nested Variant
Urothelial Carcinoma With Divergent Differentiation
Nonurothelial Malignancy
Small Cell
Squamous Cell Cancer
Adenocarcinoma
Urachal Adenocarcinoma
References
Chapter 136: Management Strategies for Non–Muscle-Invasive Bladder Cancer (Ta, T1, and CIS)
Pathology: Grading and Staging
Pathological Staging
Pathological Grading
Tumor Biology
Pathological Characteristics by Stage and Implications for Clinical Management
Endoscopic Surgical Management
Procedures
Complications of Transurethral Resection of Bladder Tumor and Bladder Biopsy
Repeat Transurethral Resection of Bladder Tumor
Random Bladder Biopsies
Laser Resection
Office-Based Endoscopic Management
Enhanced Cystoscopic Techniques: Fluorescence Cystoscopy, Narrow Band Imaging, Optical Coherent Tomography, and Confocal Laser Endomicroscopy
Intravesical Therapy
Perioperative Intravesical Therapy
Intravesical Immunotherapy
Bacille Calmette-Guérin
Mechanism of Action
Bacille Calmette-Guérin Treatment of Carcinoma in Situ
Bacille Calmette-Guérin Treatment of Residual Tumor
Bacille Calmette-Guérin Prophylaxis to Prevent Recurrence
Impact of Bacille Calmette-Guérin on Progression
Determining Optimum Bacille Calmette-Guérin Treatment Schedule
Interferon
Investigational Immunotherapeutic Agents
Intravesical Chemotherapy
Thiotepa
Doxorubicin
Valrubicin
Mitomycin C
Other Intravesical Therapeutic Agents
Combination Therapy
Refractory High-Grade Disease
Management of Refractory High-Grade Disease
Role of Alternative Options for Refractory Disease
Role of “Early” Cystectomy
Surveillance and Prevention
Cystoscopic Surveillance
Urine Cytology
Tumor Markers
Extravesical Surveillance
Secondary Prevention Strategies
Suggested Readings
References
Chapter 137: Management of Muscle-Invasive and Metastatic Bladder Cancer
Clinical Presentation, Diagnosis, and Evaluation
Natural History
Histology
Clinical Staging
Pathologic Staging
Radical Cystectomy and Pelvic Lymph Node Dissection for Muscle-Invasive Bladder Cancer
Bilateral Pelvic Lymph Node Dissection
Anatomic Extent of Pelvic Lymph Node Dissection and Landing Zones
Number of Lymph Nodes Identified at the Time of Cystectomy
Lymph Node Density and Extracapsular Nodal Extension
Intraoperative Decision Making
Grossly Positive Nodes and T4b Disease
Intraoperative Frozen Sections of the Ureter
Prostatic Urothelial Carcinoma and Management of the Distal Urethra
Managing the Female Urethra
Oncologic Outcomes Following Radical Cystectomy
Neoadjuvant Therapy for Muscle-Invasive Bladder Cancer
Adjuvant Therapy for Muscle-Invasive Bladder Cancer
Randomized Trials of Adjuvant Chemotherapy
Adjuvant Chemoradiation
Bladder Preservation
Trimodal Therapy for Surgically Fit Patients
Trimodality Therapy for Surgically Unfit Patients
Single-Modality Treatment
Radiation Monotherapy
Radical Transurethral Resection
Partial Cystectomy
Chemotherapy Monotherapy
Prognostic Nomograms for Muscle-Invasive Bladder Cancer
Management of Metastatic Bladder Cancer
Randomized Trials in Metastatic Bladder Cancer
Second-Line Chemotherapy
Single-Agent Second-Line Chemotherapy
Multiagent Second-Line Chemotherapy
Immune Checkpoint Inhibitor Therapy
Second-Line Immune Checkpoint Inhibitor Therapy
First-Line Immune Checkpoint Inhibitor Therapy in Cisplatin-Ineligible Patients
FDA-Approved Agents and Future Directions
Targeted Therapy
Vascular Endothelial Growth Factor Inhibitor Therapy
Epidermal Growth Factor Receptor Therapy
Fibroblast Growth Factor Receptor Therapy
Suggested Readings
References
Chapter 138: Surgical Management of Bladder Cancer: Transurethral, Open, and Robotic
Transurethral Resection of Bladder Tumors
Patient Preparation
Surgical Technique
Pelvic Lymphadenectomy
Radical Cystectomy: Male
Radical Cystectomy: Female
Partial Cystectomy
Robotic Radical Cystectomy
Background
Patient Selection
Patient Positioning
Port and Assistant Placement
Instrumentation
Sigmoid Release and Posterior Dissection
Lateral Space of Retzius and Anterior Vascular Pedicle Dissection
Extended Pelvic Lymphadenectomy
External Iliac Lymphadenectomy
Obturator Lymphadenectomy
Hypogastric Lymphadenectomy
Common Iliac Lymphadenectomy
Presacral Lymphadenectomy
Ureteral Control and Posterior Pedicle Dissection
Male Apical Dissection
Female Radical Cystectomy
Postoperative Care
Acknowledgments
Suggested Readings
References
Chapter 139: Use of Intestinal Segments in Urinary Diversion
Surgical Anatomy
Stomach
Small Bowel
Colon
Selecting the Segment of Intestine
Stomach
Jejunum
Ileum and Colon
Preparing the Bowel for Surgery and Postoperative Recovery
Mechanical Bowel Preparation
Antibiotic Bowel Preparation
Diarrhea and Pseudomembranous Enterocolitis
Enhanced Recovery After Surgery
Intestinal Anastomoses
Surgical Principles
Types of Anastomoses
Enteroenterostomy by a Two-Layer Suture Anastomosis
Enteroenterostomy by a Single-Layer Suture Anastomosis
End-to-Side Ileocolic Sutured Anastomosis
Ileocolonic End-to-End Sutured Anastomosis With Discrepant Bowel Sizes
Stapled Anastomoses
Ileocolonic Anastomosis with the Circular Stapling Device
Side-to-Side Stapled Anastomosis: Ileal-Ileal or Ileocolonic Anastomosis
Laparoscopic and Robotic Anastomoses
Compression Anastomoses and the Biofragmentable Ring
Complications of Intestinal Anastomoses
Fistulas
Sepsis and Other Infectious Complications
Bowel Obstruction
Hemorrhage
Intestinal Stenosis
Pseudo-Obstruction
Complications of the Isolated Intestinal Segment
Intestinal Stricture
Elongation of the Segment
Abdominal Stomas
Nipple (Rosebud) Stoma
Flush Stoma
Loop End Ileostomy
Complications of Intestinal Stomas
Ureterointestinal Anastomoses
Ureterocolonic Anastomoses
Combined Technique of Leadbetter and Clarke
Transcolonic Technique of Goodwin
Strickler Technique
Pagano Technique
Cordonnier and Nesbit Techniques
Small Bowel Anastomoses
Bricker Anastomosis
Wallace Technique
Tunneled Small Bowel Anastomosis
Split-Nipple Technique
Le Duc Technique
Hammock Anastomosis
Ureteral Dipping Technique
Ureter–Small Bowel Anastomosis Using Serosal Compression of the Extramural Ureter as an Antireflux Mechanism
Intestinal Antireflux Valves
Intussuscepted Ileocecal Valve
Intussuscepted Ileal Valve
Nipple Valve
Complications of Ureterointestinal Anastomoses
Urinary Fistula
Stricture
Pyelonephritis
Renal Deterioration
Renal Function Necessary for Urinary Intestinal Diversion
Urinary Diversion
Ileal Conduit
Procedure
Complications
Jejunal Conduit
Procedure
Complications
Colon Conduit
Procedure
Transverse Colon.
Sigmoid Colon.
Ileocecal Conduit.
Complications
Ileal Vesicostomy
Management Common to All Conduits
Metabolic and Neurochemical Problems of Urinary Intestinal Diversion
Metabolic Complications
Electrolyte Abnormalities
Altered Sensorium
Abnormal Drug Absorption
Osteomalacia
Growth and Development
Infection
Stones
Intestinal Motility, Short Bowel, and Nutritional Problems
Cancer
Neuromechanical Aspects of Intestinal Segments
Volume-Pressure Considerations
Motor Activity
Summary
References
Chapter 140: Cutaneous Continent Urinary Diversion
General Considerations
Patient Selection
Patient Preparation
Cystectomy
Postoperative Care and Comments
Continent Urinary Diversion
Rectal Bladder Urinary Diversion
Folded Rectosigmoid Bladder
Postoperative Care and Comments.
Augmented Valved Rectum
Hemi-Kock and T Pouch Procedures with Valved Rectum
Postoperative Care and Comments.
Sigma-Rectum Pouch, Mainz II
Postoperative Care and Comments.
Continent Catheterizing Pouches
General Procedural Methodology
General Care
Continent Ileal Reservoir (Kock Pouch)
Procedure.
Double T Pouch
Procedure.
Postoperative Care and Comments.
Mainz Pouch I
Procedure.
Postoperative Care and Comments.
Right Colon Pouches With Intussuscepted Terminal Ileum
Indiana Pouch
Procedure.
Postoperative Care and Comments.
Penn Pouch
Procedure.
Postoperative Care and Comments.
Gastric Pouches
Procedure.
Postoperative Care and Comments.
Quality-of-Life Assessments
Variations in Operative Technique
Minimally Invasive Continent Cutaneous Diversion
Conduit Conversion to a Continent Reservoir
Absorbable Stapling Techniques in Continent Urinary Diversion
Surgical Techniques
Right Colon Pouch
Stapled Sigmoid Reservoir
W-Stapled Reservoir
Postoperative Care and Comments.
Summary
Suggested Readings
References
Chapter 141: Orthotopic Urinary Diversion
History of Orthotopic Urinary Diversion
Basic Principles of Continent Orthotopic Urinary Diversion
Patient Selection
Oncologic Factors
Risk for Urethral Recurrence in Men
Risk for Urethral Recurrence in Women
Locally Advanced Tumor Stage
Patient-Related Factors
Age
Renal Function
Body Habitus
Manual Dexterity and Willingness to Do Self-Catheterization
Urethral Stricture Disease or External Sphincter Damage
Prior Pelvic Radiation
Prior Prostate Surgery or Bowel Resection
Continence Mechanism in Patients Undergoing Orthotopic Diversion
Surgical Techniques for Continence Preservation During Radical Cystectomy
Anterior Apical Dissection in the Male Patient
Preservation of the Urethra in the Female Patient
Techniques for Orthotopic Bladder Substitution
Choice of Bowel Segment
Need to Prevent Reflux
General Perioperative Management
Surgical Techniques
Ileal Reservoirs
Camey II
Orthotopic Kock Ileal Reservoir (Hemi-Kock)
Serous-Lined Extramural Tunnel
Ileal Neobladder (Hautmann Pouch)
Studer Pouch
T Pouch Modification
Colon and Ileocolic Pouches
Orthotopic Mainz Pouch (Mainz III)
Right Colon Pouch
Sigmoid Pouch
Padua Pouch (Vesica Ileale Padovana)
Use of Minimally Invasive Techniques for Orthotopic Diversion
Results and Complications of Orthotopic Urinary Diversion
Early and Late Complications
Continence
Urinary Retention
Follow-Up for Patients With Orthotopic Diversion
Quality of Life After Orthotopic Urinary Diversion
Suggested Readings
References
Chapter 142: Minimally Invasive Urinary Diversion
Incorporation of Robot-Assisted Approach
Patient Selection
Surgeon Choice
Preoperative Care
Enhanced Recovery After Surgery
Patient Position and Port Placement
Anatomic Considerations in Men
Anatomic Considerations in Women
Ileal Conduit
Transfer of Left Ureter and Selection of Bowel
Marionette Stitch
Isolation of the Bowel Segment and Creation of the Ileal Conduit
Ureteroileal Anastomosis
Restoration of the Bowel
Pre-Stoma Preparation
Intracorporeal Neobladder
Modified Studer Neobladder: The Karolinska Institute Technique
Configuration and Setup
Neobladder-Urethral Anastomosis
Detubularization of Bowel
Creation of Neobladder
Uretero-Neobladder Anastomosis
Closure of the Neobladder
Modified Studer Neobladder: The USC Institute of Urology Technique
Configuration and Setup
Rotation of Pouch, Neobladder-Urethral Anastomosis, and Cross-Folding of the Pouch
Uretero-Neobladder Anastomosis
Pyramid Neobladder: The University College London Hospital Technique
Configuration and Setup
Formation of the Pyramid Neobladder
Uretero-Neobladder Anastomosis
Modified Y Neobladder: The Clinique Saint-Augustin Technique
Configuration and Setup
Creation of the Neobladder
Uretero-Neobladder Anastomosis
Padua Neobladder
Configuration and Setup
Uretero-Neobladder Anastomosis
Florin: Florence Robotic Intracorporeal Neobladder
Configuration and Setup
Uretero-Neobladder Anastomosis
Modified “W” Hautmann Neobladder: The Roswell Park Comprehensive Cancer Center Technique
Configuration and Setup
Creation of the Neobladder
Uretero-Neobladder Anastamosis
Restoration of the Bowel.
Maneuvers Facilitating Neobladder-Urethral Anastomosis.
Robot-Assisted Intracorporeal Continent Cutaneous Diversion
Colon Mobilization, Isolation, and Ileocolic Anastomosis
Creation of the Colonic Pouch
Uretero-Colonic Anastomosis
Tapering of the Ileum and Imbricating the Ileocecal Valve
Postoperative Care
Outcomes
Operative Time
Learning Curve
Complications
Reoperations After Robot-Assisted Radical Cystectomy
Uretero-Enteric Strictures
Fistula and Bowel Obstruction
Abdominal Wall–Related Complications
Functional Outcomes
Continence After Creation of Neobladder.
Intracorporeal Versus Extracorporeal Diversion
Future Directions
Suggested Readings
References
Part XV: The Prostate
Chapter 143: Development, Molecular Biology, and Physiology of the Prostate
Developmental and Cell Biology
Prostate
Regional Differentiation of the Lower Urinary Tract
Prostate Budding
Cytodifferentiation
Molecular Features of Prostate Development
Induction of Prostate Budding.
Epithelial Budding.
Nkx3.1 and Sox9.
Fibroblast Growth Factors.
Wnt Signaling Pathway.
Hedgehog Signaling Pathway.
Transforming Growth Factor-β Superfamily.
Prostate Zonal and Lobar Anatomy.
Prostate Cell Types
Luminal Epithelial Cells.
Basal Cells.
Prostate Epithelial Stem Cells.
Intermediate Cells.
Neuroendocrine Cells.
Stroma and Tissue Matrix
Seminal Vesicles and Their Development
Endocrine Control of Prostate Growth
Androgen Production by the Testes
Adrenal Androgens
Estrogens in the Male
Androgen-Binding Proteins in the Plasma
Regulation of Prostate Growth by Steroids and Protein Growth Factors
Androgen Action at the Cellular Level
5α-Reductase and Androgen Metabolism Within the Prostate
Androgen Regulation of Stromal-Epithelial Interactions
Cell Adhesion Molecules
Regulation of Prostate Growth at the Molecular Level: Steroid Receptors
Androgen Receptor
Chaperonin Binding.
DNA-Binding Domain.
Ligand-Binding Domain.
Dimerization.
Post-Translational Modifications.
Nuclear Localization.
Transcriptional Activation Domains.
Androgen Receptor–Dependent Chromatin Remodeling
Role of the Nuclear Matrix in Androgen Action.
Prostatic Secretions and Proteins
Prominent, Nonpeptide Components of Prostatic Secretions
Citric Acid
Fructose
Polyamines
Phosphorylcholine
Prostaglandins
Zinc
Prostatic Secretory Proteins
Prostate-Specific Antigen
Prostate-Specific Antigen Derivatives
Human Kallikrein 2
Human Kallikrein L1
Human Kallikrein 11
Human Kallikrein 14
Prostate-Specific Transglutaminases
Semenogelins I and II.
Prostate-Specific Membrane Antigen.
Prostate Stem Cell Antigen.
Prostatic Acid Phosphatase.
Prostate-Specific Protein 94 (β-Microseminoprotein and β-Inhibin).
Protein C Inhibitor.
Leucine Aminopeptidase.
Lactate Dehydrogenase.
Immunoglobulins, C3 Complement, and Transferrin.
Zinc α2-Glycoprotein.
Seminal Vesicle Secretory Proteins.
Coagulation and Liquefaction of Semen
Prostatic Secretions and Drug Transport
Suggested Readings
References
Chapter 144: Benign Prostatic Hyperplasia: Etiology, Pathophysiology, Epidemiology, and Natural History
Etiology of Benign Prostatic Hyperplasia
Hyperplasia
The Role of Androgens
Androgen Receptors
Dihydrotestosterone and Steroid 5α-Reductase
The Role of Estrogens
Regulation of Programmed Cell Death
Stromal-Epithelial Interaction
Growth Factors
Other Signaling Pathways
The Potential Role of Inflammatory Pathways and Cytokines in Benign Prostatic Hyperplasia
Genetic and Familial Factors
Other Etiologic Factors
Pathophysiology
Pathology
Anatomic Features
Histologic Features
Importance of Prostatic Smooth Muscle
The Bladder’s Response to Obstruction
Epidemiology and Natural History
Definitions
Descriptive Epidemiologic Studies
Histologic or Autopsy Prevalence
Cross-Sectional Studies of Clinical Prevalence
Symptom Severity and Frequency
Bother, Interference, and Health-Related Quality of Life
Prostate Size
Measures of Obstruction
Analytical Epidemiologic Studies
Religion
Socioeconomic Factors
Sexual Activity and Vasectomy
Alcohol and Liver Cirrhosis
Hypertension
Smoking
Physical Activity, Diet, Obesity, Body Mass Index, and the Metabolic Syndrome
Medications
Correlations Among Parameters
Natural History of Untreated Benign Prostatic Hyperplasia
Clinical Parameters and Outcomes of Interest
Methods of Studying Natural History of Benign Prostatic Hyperplasia
Watchful Waiting Studies
Placebo and Sham Control Groups in Randomized Trials
Placebo Control Groups.
Sham Control Arms of Device Treatment Trials for BPH.
Placebo/Sham Effect and Baseline Symptom Severity.
Natural History and Disease Progression in Long-Term Placebo Arms.
Relationship Between Placebo/Sham Effect and Perception of Improvement.
Longitudinal Population-Based Studies.
Complications of Benign Prostatic Hyperplasia
Mortality
Bladder Stones
Bladder Decompensation
Urinary Incontinence
Urinary Tract Infections
Upper Urinary Tract Deterioration and Azotemia
Hematuria
Acute Urinary Retention
Descriptive Epidemiology (Table 144.16)
Analytical Epidemiology
Age.
LUTS.
Urodynamic Parameters.
Prostate Volume and Serum PSA.
Surgery for Benign Prostatic Hyperplasia
Suggested Readings
References
Chapter 145: Evaluation and Nonsurgical Management of Benign Prostatic Hyperplasia
Diagnostic Evaluation
Medical History
Symptom Assessment
Physical Examination
Frequency-Volume Charts and Bladder Diaries
Laboratory Tests
Urinalysis
Prostate-Specific Antigen
Renal Function Assessment
Instrumental Investigations
Postvoid Residual Volume
Uroflowmetry
Urodynamics
Filling Cystometry
Pressure-Flow Study
Imaging
Upper-Tract Imaging
Prostate and Bladder Imaging
Cystourethrogram
Cystourethroscopy
Other Noninvasive Tests
Practical Flowchart for the Evaluation of Patients With Lower Urinary Tract Symptoms
Management of Lower Urinary Tract Symptoms Caused by Benign Prostatic Enlargement
Conservative Management
Watchful Waiting
Lifestyle and Dietary Modifications
Medical Therapy
Impact and Trends of Medical Therapy Use for Lower Urinary Tract Symptoms
Clinical Indications
Assessment of Response to Medical Treatment: Outcome Measures
Symptoms
Bladder Outlet Obstruction
Bladder Emptying
Detrusor Overactivity
Interpreting the Literature: Bias Associated With Trials on Medical Treatment of Lower Urinary Tract Symptoms
Therapy With α1-Adrenergic Blockers
Rationale
Classification of α1-Blockers
Nonselective α1-Blockers
Selective α1-Blockers
Review of the Literature on Currently Approved α1-Blockers for the Treatment of Lower Urinary Tract Symptoms
Terazosin
Doxazosin
Alfuzosin
Tamsulosin
Silodosin
Naftopidil
Comparison of α-Adrenergic Blockers
Safety Profile of α1-Blockers in Specific Patient Populations
Hemodynamic Side Effects
α-Blocker Therapy in Patients With Cardiovascular Diseases
α1-Blockers in the Elderly
α1-Blockers and Sexual Function
Other Complications Associated with α-Blocker Therapy
Summary
Androgen Manipulation
Rationale for Androgen Manipulation
Classification of Pharmacologic Agents
Interpreting the Literature on Androgen Manipulation
Review of the Literature
Finasteride
Dutasteride
Zanoterone
Flutamide
Cetrorelix
Chlormadinone Acetate
Aromatase Inhibitors
Selective Estrogen and Androgen Receptor Modulators
Tolerability and Safety of Androgen Manipulation Therapy for Benign Prostatic Hyperplasia
5α-Reductase Inhibitors and Sexual Dysfunction
Summary
Muscarinic Receptor Antagonists
Rationale and Indication for Patients With Benign Prostatic Hyperplasia
Efficacy
Tolerability and Safety Profile
Summary
β3-Agonist (Mirabegron)
Indication, Efficacy, and Safety Profile
Phosphodiesterase Type 5 Inhibitors
Rationale and Efficacy of Phosphodiesterase Type 5 Inhibitors in Patients With Lower Urinary Tract Symptoms
Combination Therapy for Lower Urinary Tract Symptoms
α-Adrenergic Blockers and 5α-Reductase Inhibitors
Medical Therapy of Prostatic Symptoms Trial
Combination of Avodart and Tamsulosin Study
α-Adrenergic Blockers and Anticholinergic Receptor Blockers
α-Adrenergic Blockers and β3-Agonists
α-Adrenergic Blockers and Phosphodiesterase Type 5 Inhibitors
Phytotherapy
Composition of Phytotherapy Extracts
Mechanism of Action
Current Role of Phytotherapy in the Treatment of Patients With Lower Urinary Tract Symptoms
Serenoa Repens (Saw Palmetto Berry)
Pygeum Africanum (African Plum)
Hypoxis Rooperi (South African Star Grass)
Other Plant Extracts and Lycopene
Summary
Prognosis of Patients Receiving Medical Treatment for Lower Urinary Tract Symptoms
Acute Urinary Retention
Management of Acute Urinary Retention
Medical Therapy in the Prevention of Acute Urinary Retention
Future Directions in Medical Treatment of Benign Prostatic Hyperplasia
References
Chapter 146: Minimally Invasive and Endoscopic Management of Benign Prostatic Hyperplasia
Introduction
Epidemiology and Marketshare
Marketshare
Epidemiology of Surgical Treatment for Benign Prostatic Hyperplasia
Increasing Age
Effects of Medications for Benign Prostatic Hyperplasia
Prostate Size
Workup
Defining Outcomes
Response Rates
Subjective
Objective
Need for Secondary Procedures
Comparisons to Other Treatments
Presurgical Factors
Indications for Treatment
Antibiotic Coverage
Histologic Specimen
Matching Treatment with Patient
Specific Technologies
Non-LASER Options
Monopolar Transurethral Resection of the Prostate
Technique (from Preoperative Area to Recovery Room)
Preoperative.
Intraoperative.
Postoperative Care.
Outcomes.
TURP in the Anticoagulated Patient.
Complications.
Intraoperative and Perioperative Problems.
Postoperative.
Conclusion.
Bipolar Transurethral Resection of the Prostate
Concept.
Technique.
Outcomes
Single-Cohort Studies.
Comparative Studies.
Complications.
Intraoperative and Perioperative.
Postoperative.
Conclusion.
Prostatic Urethral Lift
Introduction.
Outcomes
Single-Cohort Studies.
Comparative Studies.
Complications.
Conclusion.
Convective Radiofrequency Water Vapor Thermal Therapy
Introduction.
Technique.
Outcomes
Single-Cohort Studies.
Comparative Studies.
Complications.
Conclusion.
Transurethral Vaporization of the Prostate
Introduction and Concept.
Technique
Preoperative.
Intraoperative.
Postoperative.
Outcomes.
Animal/In Vitro Studies.
Single-Cohort Studies.
Comparative Studies
Monopolar Studies.
Bipolar Studies.
Complications
Intraoperative and Perioperative.
Postoperative.
Conclusion.
Transurethral Microwave Therapy
Introduction and Concept.
Mechanism of Action.
Nerve Degeneration/Sensory Changes.
Morphology Changes.
Technique
Preoperative.
Intraoperative and Perioperative.
Postoperative.
Outcomes.
Predicting Outcomes.
Single-Cohort Studies.
Comparative Studies
TUMT vs Sham.
TUMT vs α-blocker.
TUMT vs TURP.
Complications
Intraoperative and Perioperative.
Postoperative.
Conclusion.
Transurethral Needle Ablation of the Prostate
Introduction and Concept.
Technique
Preoperative.
Intraoperative.
Postoperative.
Outcomes.
Single-Cohort Studies.
Comparative Studies.
TUNA vs. other MISTs.
TUNA vs TURP.
Complications.
Intraoperative and Perioperative.
Postoperative.
Conclusion.
Transurethral Incision of the Prostate
Introduction and Concept.
Technique.
Outcomes
Single-Cohort Studies.
Comparative Studies
TUIP vs TURP.
Complications
Intraoperative and Perioperative.
Postoperative.
Summary.
LASER Treatments
LASER Safety.
Holmium and Prostate Enucleation
Introduction and Concept.
Technique
Preoperative.
Intraoperative.
Postoperative.
Outcomes
Single-Cohort Series.
Comparative Series
HoLEP vs. TURP.
HoLEP vs. Open Prostatectomy.
HoLEP in the Anticoagulated Patient.
Complications
Intraoperative and Perioperative.
Postoperative.
Conclusion.
Prostate Ablation and Vaporization
Concept and Introduction.
Technique
Preoperative.
Intraoperative.
Postoperative.
Outcomes.
Single-Cohort Studies.
Comparative Studies.
Use of Photoselective Vaporization in Anticoagulated Patients.
Complications
Intraoperative and Perioperative.
Postoperative.
Conclusion.
Thulium
Concept and Introduction.
Technique.
Outcomes
Single-Cohort Series.
Comparative Series
Thulium Resection vs. TURP.
Thulium Enucleation vs. HoLEP.
Complications
Intraoperative and Perioperative.
Postoperative.
Conclusion.
Failed, Failing, and Future Directions
Prostate Stents
Concept
Data
Conclusion
Temporary Implantable Nitinol Device
Concept
Data
Verdict
Aquablation (Aquabeam)
Concept
Data
Verdict
Prostate Embolization
Concept
Data
Single-Cohort Studies.
Comparative Studies.
Verdict
Prostatic Injections
Concept
Data
PRX302.
Anhydrous Ethanol.
Botulinum Toxin.
Verdict
Conclusion
Suggested Readings
References
Chapter 147: Simple Prostatectomy: Open and Robotic-Assisted Laparoscopic Approaches
Indications for Simple Prostatectomy
Preoperative Evaluation
Operating Day Preparation
Surgical Technique
Anesthesia
Open Simple Prostatectomy (Retropubic and Suprapubic Approach)
Proper Positioning of the Patient
Incision and Development of the Space of Retzius
Retropubic Simple Prostatectomy
Exposure of the Prostate
Hemostatic Maneuvers
Enucleation of the Adenoma
Suprapubic Simple Prostatectomy
Exposure of the Prostate
Enucleation of the Adenoma
Hemostatic Maneuvers
Closure
Postoperative Management
Robotic-Assisted Laparoscopic Simple Prostatectomy (Video 147.1)
Proper Positioning of the Patient
Abdominal Access, Insufflation, and Trocar Placement
Development of the Space of Retzius
Bladder Neck Incision
Enucleation of the Adenoma
Hemostasis and Vesicourethral Anastomosis
Adenoma Extraction and Closure
Postoperative Management
Complications of Simple Prostatectomy
Summary
Suggested Readings
References
Chapter 148: Epidemiology, Etiology, and Prevention of Prostate Cancer
Epidemiology
Incidence and Mortality Trends
Incidence
Mortality
Racial Differences
Global Incidence and Mortality
Age at Diagnosis
Stage at Diagnosis
Effect of Screening on Incidence and Mortality
Risk Factors
Familial and Germline Genetic Influences
Inflammation and Infection
Molecular Epidemiology
Androgens
Estrogens
Insulin-like Growth Factor Axis
Leptin
Vitamin D, Vitamin D Receptor, and Calcium
Other Influences
Sexual Activity/Sexually Transmitted Diseases.
Vasectomy.
Smoking.
Diet.
Obesity.
Alcohol Consumption.
Etiology and Molecular Genetics
The Influence of Androgens
Stem Cells
Somatic Genetic Changes Associated With Tumor Initiation and Progression
The Cancer Genome Atlas and Its Findings
Tumors Defined by Gene Fusions
ETS Family Gene Fusions
Other Gene Fusions
Tumors Defined by Mutations (SPOP, FOXA1, IDH1)
Epigenetic Changes
Androgen Receptor
DNA Repair Defects and Other Alterations
Differences Between African-Americans and Caucasians
An Integrated Model of Prostate Cancer Tumorigenesis
Chemoprevention
Rationale
Pharmacologic Agents
5α-Reductase Inhibitors
Prostate Cancer Prevention Trial
Reduction by Dutasteride of Prostate Cancer Events Trial
Summary: PCPT and REDUCE
Toremifene Citrate
Other Pharmacologic Agents
Vitamins and Micronutrients
Selenium and Vitamin E
The Selenium and Vitamin E Cancer Prevention Trial
Conclusion
References
Chapter 149: Prostate Cancer Biomarkers
Biomarker Development
Assessment of Biomarker Performance
Blood-Based Biomarkers
Prostate-Specific Antigen (PSA or hK3)
Free Prostate-Specific Antigen
Free Prostate-Specific Antigen Isoforms
Prostate-Specific Membrane Antigen
Human Kallikrein 2
Circulating Tumor Cells and Circulating Tumor DNA
Urine-Based Biomarkers
PCA3
Gene Fusions
Other Urine Biomarkers
Annexin A3
miRNA
Tissue-Based Biomarkers
α-Methylacyl Coenzyme A Racemase
Epigenetic Modifications
Genomic Expression Profiles
Inherited Genetic Markers
Summary
Suggested Readings
References
Chapter 150: Prostate Biopsy: Techniques and Imaging
Ultrasonographic Anatomy of the Prostate
Gray-Scale Transrectal Ultrasonography
Machine Settings
Techniques
Probe Manipulation
Volume Calculations
Cystic Lesions of the Prostate
Prostate Cancer Imaging on Transrectal Ultrasonography
Transrectal Ultrasonography Appearance After Treatment
Transrectal Ultrasonography and Other Malignancies
Prostate Biopsy: Techniques and Outcomes
Indications for Prostate Biopsy
Contraindications to Prostate Biopsy
Preparing Patients for Biopsy
Antibiotic Prophylaxis
Cleansing Enema
Analgesia
Patient Positioning
Transrectal Prostate Biopsy Techniques
Sextant Biopsy
Extended-Core Biopsy Techniques
Repeat and Saturation Prostate Biopsy
Transperineal Prostate Biopsy
Transurethral Prostate Biopsy
Risks and Complications of Prostate Biopsy
Postbiopsy Infections
Bleeding
Other Complications
Advanced and Investigational Techniques for Prostate Biopsy
Color and Power Doppler Transrectal Ultrasonography
Other Newer and Investigational Imaging and Biopsy Techniques
Multiparametric Prostate Ultrasonography
Multiparametric Magnetic Resonance Imaging of the Prostate
Suggested Readings
References
Chapter 151: Pathology of Prostatic Neoplasia
Prostatic Intraepithelial Neoplasia
Adenocarcinoma
Staging Classification
Location
Spread of Tumor
Tumor Volume
Grade
Assessment of Needle Biopsy Specimens
Processing
Differential Diagnosis
Prognosis
Assessment of Transurethral Resection Specimens
Processing
Differential Diagnosis
Assessment of Radical Prostatectomy Specimens
Assessment
Prognosis
Gleason Score.
Lymph Node Metastases.
Extraprostatic Extension and Seminal Vesicle Invasion.
Margins.
Tumor Volume.
Perineural and Vascular Invasion.
Adenocarcinoma With Treatment Effect
Subtypes of Prostate Adenocarcinoma
Mesenchymal Tumors
Urothelial Carcinoma
Miscellaneous Malignant Tumors
Suggested Readings
References
Chapter 152: Diagnosis and Staging of Prostate Cancer
Diagnosis
Screening
General Concepts of Screening
Randomized Trials
Specialty Group Recommendations
Diagnostic Modalities
Digital Rectal Examination
Prostate-Specific Antigen
Factors Influencing Prostate-Specific Antigen.
Clinical Use for Diagnosis.
Triggers for Biopsy.
Prostate-Specific Antigen Derivatives and Molecular Forms
Volume-Based Prostate-Specific Antigen Parameters.
Prostate-Specific Antigen Velocity.
Free Prostate-Specific Antigen.
Complexed Prostate-Specific Antigen.
Prostate-Specific Antigens Isoforms.
Human Kallikrein 2.
Multiplex Tests.
Other Markers
Staging
General Concepts of Staging
Clinical Versus Pathologic Staging
Classifications
Prediction of Tumor Extent
Prostate-Specific Antigen
Digital Rectal Examination
Prostate Needle Biopsy
Combined Use of Pretreatment Parameters
Imaging
Molecular Staging
Pelvic Lymphadenectomy
Suggested Readings
References
Chapter 153: Active Management Strategies for Localized Prostate Cancer
Host Evaluation
Longevity Assessment and Competing Risks for Mortality
Baseline Urinary, Sexual, and Bowel Function
Bladder Function
Sexual Function
Bowel Function and Other Conditions Affecting Treatment Choice
Patient Preference and Biases
Assessment of Prostate Cancer Risk
Tools for Risk Stratification
Definitions of Low, Intermediate, and High Risk
Gleason Scoring and Grade Groups
Epstein Criteria
Staging
Nomograms for Prediction of Stage
Risk Stratification Nomograms
Prostate Magnetic Resonance Imaging in Risk Assessment
Genomic Tests for Risk Stratification
Selection of Treatment: Comparative Studies
Oncologic Outcomes
Comparative Population-Based Studies
Scandinavian Prostate Cancer Group Study Number 4.
PIVOT.
Prostate Cancer Outcomes Study.
ProtecT.
Functional Outcomes
Prostate Cancer Outcomes Study.
ProtecT.
Comparative Effectiveness Analysis of Surgery and Radiation.
Open versus Robotic Prostatecomy.
Patient Counseling: a Stepwise Decision Approach
Decision One: Observation versus Active Treatment
Decision Two: Partial Gland versus Whole Gland Treatment
Decision Three: Surgery vs. Radiation versus Whole-Gland Ablation
Decision Four: Type of Treatment Delivery
Conclusion
References
Chapter 154: Active Surveillance of Prostate Cancer
The Overdiagnosis and Overtreatment Problem
The Natural History of Prostate Cancer
Molecular Genetics of Gleason Pattern 3 Versus Patterns 4 and 5
Natural History
Outcome of Active Surveillance
Patient Selection
Watchful Waiting
Management of Men on Active Surveillance
Other Risk Factors
Race
Family History
Monitoring
Magnetic Resonance Imaging
Biomarkers
Genomic Classifier
Genomic Prostate Score
Cell Cycle Progression
Caveats of Tissue-Based Genomics
Psychological Aspects
Lifestyle Management
Smoking Cessation
Exercise
Weight Control
Diet
Micronutrients
Pharmacologic Intervention
Summary
GAP 3
Barriers to Active Surveillance
Nomenclature
Economics
Research Questions
Conclusion
References
Chapter 155: Open Radical Prostatectomy
Radical Retropubic Prostatectomy: Surgical Anatomy
Venous and Arterial Anatomy
Pelvic Plexus
Striated Urethral Sphincter
Pelvic Fascia
Surgical Technique
Preoperative Preparation
Special Instruments
Anesthesia, Incision, and Lymphadenectomy
Exposure
Incision in the Endopelvic Fascia
Division of the Puboprostatic Ligaments
Preservation of Accessory Pudendal Arteries
Ligation and Division of the Dorsal Vein Complex
Division of the Dorsal Vein Complex
Division of the Urethra and Placement of Urethral Sutures
Identification and Preservation of the Nerve Bundle
Identification of the Neurovascular Bundle
Standard Preservation of the Neurovascular Bundles
High Anterior Release of the Neurovascular Bundles at the Apex
Wide Excision of the Neurovascular Bundles
Posterior Dissection and Division of the Lateral Pedicles
Division of the Bladder Neck and Excision of the Seminal Vesicles
Bladder Neck Reconstruction and Anastomosis
Postoperative Management
Complications
Intraoperative Complications
Postoperative Complications
Thromboembolic Events
Bladder Neck Contracture
Urinary Incontinence
Erectile Dysfunction
Summary of Radical Retropubic Prostatectomy
Suggested Readings
References
Radical Retropubic Prostatectomy
Radical Perineal Prostatectomy
Chapter 156: Laparoscopic and Robotic-Assisted Laparoscopic Radical Prostatectomy and Pelvic Lymphadenectomy
Evolution of Minimally Invasive Laparoscopic Prostatectomy
Patient Selection
Indications and Contraindications
Use of Preoperative Multiparametric Magnetic Resonance Imaging
Instrumentation
Preoperative Preparation
Patient Preparation
Informed Consent
Operating Room Personnel
Patient Positioning
Anesthesia Considerations
Surgical Technique
Robotic-Assisted Versus Pure Laparoscopic Approach
Transperitoneal Approach
Abdominal Access, Insufflation, and Trocar Placement
Extraperitoneal Approach
Pros and Cons of Extraperitoneal Versus Transperitoneal Approach
Developing the Space of Retzius
Ligation of the Deep Dorsal Venous Complex
Bladder Neck Identification and Transection
Dissection of the Seminal Vesicles and Vasa Deferentia
Development of the Plane Between the Prostate and Rectum
Prostatic Pedicle Control
Preservation of the Neurovascular Bundle
Apical Dissection
Intraoperative Inspection of Prostate
Pelvic Lymphadenectomy
Entrapment of Specimens
Bladder Neck Reconstruction
Posterior Support of the Vesicourethral Anastomosis
Vesicourethral Anastomosis
Delivery of the Specimens and Exiting the Abdomen
Postoperative Management
Pain Management Post-Prostatectomy
Diet
Deep Venous Thrombosis Prophylaxis
Pelvic Drain
Urethral Catheter
Return to Normal Activity
Role of Continence Physiotherapy
Role of Penile Rehabilitation
Robotic Prostatectomy Outcomes
Complications of Robotic Prostatectomy
Patient Positioning: Neural Injury
Blood Loss/Transfusion
Bowel Injury
Ureteral Injury
Robotic Machine Failure
Postoperative Complications
Intraperitoneal Urine Leak
Bladder Neck Stricture
Pelvic Node Dissection Complications
Quality-of-Life Outcomes After Radical Robotic Prostatectomy
Functional Outcomes
Urinary Continence After Robotic Radical Prostatectomy
Erectile Dysfunction After Robotic Radical Prostatectomy
Oncologic Outcomes of Robotic Radical Prostatectomy
Salvage Robotic-Assisted Radical Prostatectomy
Salvage Prostatectomy Technique
Minimally Invasive Pelvic Lymph Node Dissection
Indications
Surgical Technique
Complications
Genomic Research on Fresh Prostatic Cancer Tissues and Tissue Banking
Future of Robotic Surgery
Summary
References
Chapter 157: Radiation Therapy for Prostate Cancer
Historical Perspective and Technological Advances
High-Energy Linear Accelerators
CT-Based Treatment Planning and Three-Dimensional Conformal Radiotherapy
Intensity-Modulated Radiation Therapy
Image-Guided Radiation Therapy and Treatment Margins
Multiparametric Magnetic Resonance Imaging in Radiation Treatment Planning
Transrectal Ultrasound-Guided Brachytherapy
External Beam Radiation Treatment (Also See Outcomes for External Beam Radiation)
Fractionation in Radiation Therapy
Radiobiologic Basis for Hypofractionation
Stereotactic Body Radiation Therapy
Heavy Particle Beams/Proton Therapy
Brachytherapy
Low-Dose-Rate Brachytherapy Technique and Trends
Assessment of Permanent Implant Quality
High-Dose-Rate Brachytherapy
High Dose Rate as a Boost With External Beam Radiation Therapy
High-Dose-Rate Monotherapy
Patient Selection for Brachytherapy
Brachytherapy Combined With External Irradiation
Androgen Suppression Combined With Radiation
Background and Potential Mechanisms
Androgen Suppression Therapy and Localized Disease
Androgen Suppression Therapy and Locally Advanced Disease
Benefit of Radiation in Addition to Androgen Suppression for Locally Advanced Disease
Optimal Duration of Androgen Suppression
Role of Prophylactic Pelvic Nodal Treatment
Treatment Morbidity and Quality-of-Life Outcomes
Rectal Toxicity and Management
Rectal-Sparing Strategies
Urinary Toxicity and Management
Erectile Dysfunction and Management
Evaluating the Response to Radiation Therapy
Prostate-Specific Antigen Follow-up: Definition of Failure
Significance of Time to Nadir
Significance of Nadir Value and Doubling Time
Brachytherapy and the Benign Bounce Phenomenon
Biochemical Failure and Impact of Neoadjuvant Hormones
Post–Radiation Therapy Imaging
Post–Radiation Therapy Biopsy, Timing, and Interpretation
Imaging and Sampling Error
Treatment Efficacy
Outcomes for External Beam Radiotherapy
Role of Radiation Therapy in High-Risk or Locally Advanced Disease
Outcomes for External Beam Hypofractionation
Outcomes for Brachytherapy
Comparative Efficacy of External Beam Radiation Therapy Versus Brachytherapy
Brachytherapy Combined With External Irradiation
Suggested Readings
References
Chapter 158: Focal Therapy for Prostate Cancer
Introduction
Concepts and Historical Perspective
Biologic Basis for Prostate Focal Therapy
Using Cancer Grade as an Indication of Aggressiveness
Multifocality of Prostate Cancer Versus the Index Lesion Hypothesis
Clinical Applications of Focal Therapy
Treating the Index Lesion
The Complementary Roles of Focal Therapy and Active Surveillance
Patient Selection
Biopsy-Based Lesion Identification
Advanced Imaging Techniques in Prostate Cancer
Multiparametric Magnetic Resonance Imaging
MRI-Targeted/Fusion Biopsy
Promising Imaging Modalities
Positron Emission Tomography (PET)
Multiparametric Ultrasonography
Contemporary Patient Selection Criteria
Ablation Patterns and Current Technologies
Types of Ablation
Ablation Approach
Cryotherapy
High-Intensity Focused Ultrasonography
Laser
Irreversible Electroporation
Vascular-Targeted Photodynamic Therapy
Brachytherapy
Other Modalities
Adjuvants to Focal Therapy
Post–Focal Therapy Follow-Up
Conclusions and Areas for Future Research
References
Chapter 159: Treatment of Locally Advanced Prostate Cancer
Definition
Contemporary Risk Assessment
Imaging Modalities
Novel Markers
Trends in Incidence and Treatment
Natural History
Radical Prostatectomy
Surgery for Clinical Stage T3 Prostate Cancer
Outcomes of Prostatectomy for Pathologically Advanced Disease
Outcomes of Prostatectomy for Node-Positive Disease
Neoadjuvant Androgen Deprivation
Neoadjuvant Chemotherapy and Chemotherapy–Hormonal Therapy
Adjuvant Radiation Therapy
Adjuvant Androgen Deprivation
Radiation Therapy
Neoadjuvant Androgen Deprivation and Radiation Therapy
Adjuvant Androgen Deprivation and Radiation Therapy
Radiation Therapy and Chemotherapy
Focal Ablative Therapy
Cryoablation
High-Intensity Focused Ultrasonography
Androgen Deprivation and Its Timing
Intermittent Androgen Deprivation
Quality of Life
Management of Delayed Sequelae
Clinical Trials
Suggested Readings
References
Chapter 160: Management Strategies for Biochemical Recurrence of Prostate Cancer
Radical Prostatectomy
Definition of Biochemical Recurrence After Radical Prostatectomy
The Prediction of Biochemical Recurrence Postprostatectomy
Natural History of Biochemical Recurrence Postprostatectomy
Ultrasensitive Prostate-Specific Antigen
Imaging in Patients With Biochemical Recurrence After Radical Prostatectomy
Salvage Radiation Therapy
Dose Response With Salvage Radiation Therapy
Concurrent Androgen Deprivation Therapy With Salvage Radiation
Whole Pelvis Versus Prostatic Bed Radiation Therapy
Salvage Versus Adjuvant Radiation Therapy for Prostate Cancer
Androgen Deprivation Therapy for Biochemical Failure After Radical Prostatectomy
Radiation Therapy
PSA Recurrence After Definitive Radiotherapy
Postradiation PSA Bounce
Natural History of PSA Recurrence After Definitive Radiation
Biopsy After Radiotherapy
Imaging After Biochemical Recurrence Following Radiotherapy
Salvage Radical Prostatectomy
Salvage Cryotherapy
Salvage Brachytherapy
Salvage High-Intensity Focused Ultrasonography
Androgen Deprivation Therapy After Biochemical Recurrence Following Radiation Therapy to the Prostate
Summary
References
Chapter 161: Hormonal Therapy for Prostate Cancer
Historical Overview
Molecular Biology of the Androgen Axis
Sources of Androgen
Mechanisms of Androgen Blockade
Orchiectomy
Antiandrogens
Steroidal First Generation
Nonsteroidal First- and Second-Generation
Flutamide.
Bicalutamide.
Nilutamide.
Nonsteroidal Second Generation
Enzalutamide.
Apalutamide.
Antiandrogen Withdrawal Syndrome
Inhibition of Luteinizing Hormone–Releasing Hormone
Luteinizing Hormone–Releasing Hormone Agonists
Luteinizing Hormone–Releasing Hormone Antagonists
Inhibition of Androgen Synthesis
Aminoglutethimide
Ketoconazole
Abiraterone
Clinical Follow-Up on Hormonal Therapy
Response to Androgen Blockade
Prognostic Model
Prostate-Specific Antigen Metrics
Other Clinical Predictors
Bone Scan Index
Genomic Predictors
General Complications of Androgen Ablation
Osteoporosis
Hot Flashes
Sexual Dysfunction (Erectile Dysfunction and Loss of Libido)
Cognitive Function
Changes in Body Habitus
Diabetes and Metabolic Syndrome
Cardiovascular Morbidity and Mortality
Gynecomastia
Anemia
Combination Therapy
With Radical Prostatectomy
With Radiation Therapy
Combination Hormonal Therapy
With Chemotherapy
Timing of Therapy
Continuous Androgen Deprivation Therapy: Immediate Versus Delayed
Results in Clinically Localized Disease
Results in Lymph Node Metastatic Prostate Cancer as Adjuvant Therapy
Results in Locally Advanced or Asymptomatic Metastatic Disease or Disease Not Suitable to Local Treatment
Results in Biochemically Recurrent Prostate Cancer
Immediate Versus Delayed Androgen Deprivation Therapy: Integrating the Data
Intermittent Versus Continuous Androgen Deprivation Therapy
Emerging Androgen Receptor–Associated Biomarkers
Androgen Receptor Splice Variants
Androgen Receptor Gene Amplification and Mutation
References
Chapter 162: Treatment of Castration-Resistant Prostate Cancer
Clinical Considerations
Disease Assessment and Prognostic Considerations
Nonmetastatic Castration-Resistant Prostate Cancer
Metastatic Castration-Resistant Prostate Cancer
Cytotoxic Chemotherapy
Evaluation of Treatment Efficacy
Chemotherapeutic Agents
Mitoxantrone
Docetaxel
Cabazitaxel
Platinum Agents
Next-Generation Hormonal Therapies
CYP17 Inhibition: Abiraterone and Other Agents
Androgen Receptor Modulation: Enzalutamide, Apalutamide, and Other Agents
AR-V7: A Potential Treatment-Selection Marker
Immunotherapy
Sipuleucel-T
ProstVac-VF
Immune Checkpoint Blockade
Pembrolizumab for Microsatellite Instability-High Cancers
Targeted Treatments
Rational Target Overview
PI3K/Akt/mTOR Pathway
Angiogenesis
c-Met Signaling
Apoptosis Pathway
Targeting DNA Repair
Palliative Management
Pain and Spinal Cord Compression
Bone-Targeted Approaches
Bisphosphonates
RANK Ligand Inhibitors
Radium-223 and Other Radiopharmaceuticals
Neuroendocrine Prostate Cancer
Conclusion
Suggested Readings
References