Campbell–Walsh–Wein Urology

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Cleaned hardcover version with corrected pagination, page orientation and bookmarks. 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 (