Blandy's Urology

Description

Die 3. Auflage von Blandy's Urology ist auf dem besten Weg, ein Klassiker zu werden. Die neueste Auflage eines der popul�rsten Fachb�1/4cher der Urologie vereint erfolgreich alles Wissenswerte zur allgemeinen Urologie und Chirurgie in der Urologie f�1/4r die Zielgruppe der Urologen und Chirurgen. Hauptmerkmal ist die einzigartige Art und Weise von Blandy, urologische Erkrankungen und deren Management zu beschreiben: - Klare, direkte und unkomplizierte Beschreibungen von Krankheiten und St�rungen mit Hunderten klinischer Fotos. - Eine F�1/4lle exzellenter Schaubilder zu chirurgischen Eingriffen, die die besten Operationstechniken verdeutlichen. - Legt den Nachdruck auf die h�ufigsten Erkrankungen in der klinischen Praxis. - Jedes Thema ist einem anatomischen Bereich zugeordnet. Ein Fachbuch, das wegen seines direkten Zugangs zu dem Fachgebiet vor allem von Urologen und angehenden Chirurgen gesch�tzt wird. Eignet sich auch f�1/4r die Pr�1/4fungsvorbereitung und als Auffrischung Cover Title Page Copyright Page Contents Preface List of Contributors Part I Chapter 1 Armaments in Urology Chapter 1.1 Principles of Urological Technology 1.1.1 Optics in Urology 1.1.1.1 The Rod-Lens System 1.1.1.2 Fibre-optic Flexible Endoscopes 1.1.2 Surgical Energy 1.1.2.1 Diathermy 1.1.2.2 Contact Diathermy 1.1.2.3 Noncontact Cutting 1.1.3 Dangers 1.1.3.1 Electrocution 1.1.3.2 Fire and Explosion 1.1.3.3 Burns 1.1.3.4 Neuromuscular Stimulation: The ‘Obturator Twitch’ 1.1.3.5 Pacemakers and Diathermy 1.1.4 Urological Diathermy 1.1.4.1 LigaSure Diathermy 1.1.4.2 Harmonic Scalpel 1.1.5 Lasers in Urology 1.1.5.1 Basis of Energy Generation in LASERs 1.1.5.2 Laser Interface with Tissue 1.1.5.3 Clinical Applications 1.1.5.3.1 Lasers in the Management of Urinary 1.1.5.3.2 Lasers in BPE 1.1.6 Catheters 1.1.6.1 Indications 1.1.6.2 Complications of Catheters 1.1.6.2.1 Treatment 1.1.7 Stents 1.1.7.1 Complications 1.1.8 Guidewires References Chapter 1.2 Wound Healing in the Urinary Tract 1.2.1 Introduction 1.2.2 Wound-Healing Process 1.2.3 VascularResponse 1.2.4 Cellular Response 1.2.5 Urinary Tract Healing 1.2.6 Different Methods of Making Surgical Incisions 1.2.7 Von Brunn’s Nests and Metaplasia 1.2.8 Squamous Metaplasia 1.2.9 Heterotopic Ossification 1.2.10 Regeneration of Smooth Muscle in the Urinary Tract 1.2.11 Particular Effects of Urine 1.2.11.1 The Presence of Urine Modifies the Normal Process of Healing in the Urinary Tract 1.2.12 Suture Materials, Splints, Meshes, and Films 1.2.12.1 Suture Materials 1.2.12.2 Synthetic Absorbable Suture Materials 1.2.12.3 Meshes 1.2.12.4 Injectable Agents References Chapter 1.3 Simulation in Urology 1.3.1 Introduction 1.3.2 History of Simulationin Medicine 1.3.3 Simulation Modalities 1.3.4 Simulation in Urology 1.3.5 Endourology Simulation 1.3.6 Laparoscopy Simulation 1.3.7 Robotic Surgery Simulation 1.3.8 Nontechnical Skills Simulation 1.3.9 Simulation Training Curriculums 1.3.10 Assessment of Trainees 1.3.11 Future of Simulation References Chapter 2 Principles of Medical Statistics 2.1 Introduction 2.2 Descriptive Statistics 2.2.1 Qualitative or Categorical Data 2.2.2 Quantitative or Numerical Data 2.3 Confidence Intervals 2.4 Significance Tests 2.4.1 What Statistical Test Should Be Used? 2.5 Relationships between Variables 2.5.1 Correlation 2.5.2 Prediction 2.6 Diagnostic Tests 2.7 Study Design 2.7.1 Observational Studies 2.7.2 Experimental Studies 2.7.3 Sample Size 2.8 Number Needed to Treat 2.9 Systematic Reviews and Meta‐Analysis References Chapter 3 Embryology for the Urologist 3.1 Historical Consideration 3.2 Introduction 3.3 Embryology of the Kidneys and Ureters 3.3.1 Relevant Congenital Malformations 3.4 Embryology of the Bladder 3.4.1 Relevant Congenital Malformations 3.5 Embryology of the Indifferent Genital System 3.6 Embryology of the Male Genital System 3.6.1 The Descent of the Testis 3.6.2 Relevant Congenital Malformations 3.7 Embryology of the Prostate 3.8 Embryology of the Penis and Urethra 3.9 Neuter State 3.10 Embryology of the Female Genital System 3.11 Embryology of the Adrenal Gland References Chapter 4 Principles of Urologic Oncology 4.1 The Scope of Urologic Oncology 4.2 Carcinogenesis 4.2.1 Genetics of Cancer 4.2.2 Mitotic Cycle 4.2.3 Genetic Instability of Cancer 4.2.4 Oncogenes and Tumour Suppressor Genes 4.3 Molecular Biology of Cancer Growth 4.3.1 Sustaining Proliferation 4.3.2 Evading Growth Suppressors 4.3.3 Resisting Cell Death 4.3.4 Enabling Replicative Immortality 4.3.5 Inducing Angiogenesis 4.3.6 Invasion and Metastasis 4.4 Tumour-Promoting Inflammation 4.5 Reprogramming Energy Metabolism 4.6 Evading Immune Destruction 4.7 The Tumour Microenvironment 4.8 The Rate of Cancer Growth 4.9 Principles of Treatment 4.9.1 Diagnosing and Treating Solid Tumours 4.9.2 Estimating Prognosis by Staging, Risk Stratification, and Nomograms 4.9.3 When to Treat and When Not to Treat 4.9.4 Active Surveillance and Watchful Waiting 4.10 Oncologic Surgery 4.10.1 Surgery of the Primary Tumour 4.10.2 General Principles in Tumour Surgery 4.10.3 Regional Lymphadenectomy 4.10.4 Surgery for Metastatic Disease 4.10.5 Radiotherapy 4.10.5.1 Radiosensitivity of the Urogenital Tract 4.10.6 Chemotherapy 4.10.7 Targeted Drugs 4.10.8 Immunotherapy 4.10.9 Radionuclide Treatment 4.10.10 Multimodal Treatment 4.10.11 Interdisciplinary Care and Centralization References Part II Chapter 5 Kidney and Ureter Anatomy 5.1 Comparative Anatomy 5.1.1 Topographical Anatomy 5.1.2 Anatomical Relations 5.2 Renal Fasciae 5.3 Macroscopic Appearances 5.4 Arterial Supply 5.5 Renal Veins 5.6 Common Vascular and Anatomic Variations 5.7 Lymphatics 5.8 Innervation of the Kidney 5.8.1 The Nephron 5.8.2 The Glomerulus 5.8.3 Renal Papillae, Calyces, and Pelvis 5.8.4 The Ureters 5.8.4.1 The Anatomic Relations of the Ureter 5.8.4.2 The Calibre of the Ureters 5.8.5 Renal Pelvis and Ureteral Blood Supply 5.8.5.1 Ureteral Innervation 5.8.5.2 Renal and Ureteric Pain References Chapter 6 Kidney and Ureter Physiology 6.1 Glomerular Filtration Rate 6.1.1 Disorders of Glomerular Filtration 6.2 Renal Tubules 6.2.1 Proximal Convoluted Tubules 6.2.2 Loop of Henle 6.2.2.1 The Countercurrent Theory 6.2.3 Distal Convoluted Tubule 6.2.4 Collecting Ducts 6.3 Hormonal Function of the Kidney 6.3.1 Renin 6.3.2 Erythropoietin 6.3.3 Vitamin D 6.4 Special Disorders of Renal Tubules 6.4.1 Hartnup Disease 6.4.2 Fanconi Syndrome 6.4.3 Renal Glycosuria 6.4.4 Renal Tubular Acidosis 6.4.5 Nephrogenic Diabetes Insipidus 6.5 Acid–Base Metabolism 6.6 Obstructive Uropathy 6.7 Ureteric Physiology 6.8 Whitaker Test References Chapter 7 Renal Failure 7.1 Acute Kidney Injury 7.1.1 Definition 7.1.2 Stages of AKI 7.1.3 Classification of AKI 7.1.3.1 Prerenal AKI 7.1.3.2 Intrinsic AKI 7.1.3.3 Postrenal or Obstructive AKI 7.1.4 Clinical Assessment 7.1.4.1 Investigations 7.1.5 Management 7.1.5.1 Early Nephrology Consultation 7.1.5.2 Correction of Prerenal States and Maintenance of Haemodynamic Stability 7.1.5.3 Treatment of Complications 7.1.5.4 Medication Management 7.1.5.5 Other Supportive Care 7.1.5.6 Renal Replacement Therapy 7.2 Chronic Kidney Disease 7.2.1 Clinical Assessment 7.2.2 Complications and Their Management 7.2.2.1 Volume Overload 7.2.2.2 Electrolyte and Acid–Base Imbalances 7.2.2.3 Skin Manifestations 7.2.2.4 Anaemia 7.2.2.5 Neurologic Manifestations 7.2.2.6 Hypertension 7.2.2.7 Mineral Bone Disease 7.2.2.8 Amyloidosis 7.2.2.9 Other Uraemic Features 7.2.3 Renal Replacement Therapy 7.3 Dialysis 7.3.1 Peritoneal Dialysis 7.3.1.1 Complications Associated with PD 7.3.2 Haemodialysis 7.3.2.1 Principles 7.3.2.2 Vascular Access 7.3.2.3 Complications of HD 7.3.3 Continuous Renal Replacement Therapies (CRRT) 7.3.4 Conservative Management References Chapter 8 Renal Transplant 8.1 The Patients and the Kidneys 8.1.1 Organs for Transplantation 8.1.2 Organ Allocation 8.1.3 Waiting Lists and Preparationof the Recipient 8.1.4 Selecting Donors 8.1.5 Kidneys from Living Donors 8.2 Technique of Removal of Donor Kidneys 8.2.1 Cadaver Donor 8.2.2 Living Donor 8.2.2.1 Preservation of the Kidney 8.2.2.2 Inserting the Kidney 8.2.2.3 Postoperative Complications 8.2.2.4 Delayed Graft Function 8.3 Immunology of Organ Transplantation 8.3.1 The Major Histocompatibility Complex 8.3.2 The Human Leucocyte Antigen System 8.3.3 The ABO Blood Group System 8.3.4 HLA-Typing in Renal Transplantation 8.3.5 Cross-Matching and Preformed Antibodies 8.4 Graft Rejection 8.4.1 Reperfusion Injury 8.4.2 Adaptive Immunity 8.4.3 Antigen Presentation 8.4.4 Types of Immune Response 8.4.5 Migration of Activated Cells 8.4.6 Graft Destruction 8.4.7 Clinical Types of Rejection 8.4.8 Hyperacute Rejection 8.4.9 Acute Rejection 8.4.10 Chronic Rejection 8.5 Immunosuppression 8.5.1 Corticosteroids 8.5.2 Azathioprine 8.5.3 Calcineurin Inhibitors: Cyclosporine and Tacrolimus 8.5.3.1 Cyclosporine 8.5.3.2 Tacrolimus 8.5.4 Mycophenolate Mofetil (MMF) 8.5.5 mTOR Inhibitors 8.5.6 Antibodies 8.5.7 Belatacept 8.5.8 Side Effects of Immunosuppression 8.5.9 Immunosuppressive Treatment Regimens 8.5.9.1 Induction Treatment 8.5.9.2 Maintenance Treatment 8.5.10 Treatment of Rejection 8.5.11 Pregnancy after Renal Transplantation 8.5.12 Long-Term Treatment of the Recipient after Renal Transplantation References Chapter 9 Kidney and Ureter: Congenital and Acquired Anomalies 9.1 Introduction 9.2 Congenital Abnormalities of the Kidney 9.2.1 Embryology 9.2.2 Anomalies in Number 9.2.2.1 Supernumerary Kidney 9.2.2.2 Unilateral Renal Agenesis 9.2.2.3 Bilateral Renal Agenesis (Potter Syndrome) 9.2.3 Anomalies of Rotation 9.2.4 Anomalies of Ascent 9.2.4.1 Renal Ectopia 9.2.4.2 Thoracic Kidney 9.2.5 Anomalies of Fusion 9.2.5.1 Horseshoe Kidney 9.2.5.2 Crossed Renal Ectopia 9.2.5.3 Cystic Renal Disease 9.2.5.4 Medullary Sponge Kidney 9.2.5.5 Autosomal Dominant Polycystic Kidney Disease 9.2.5.6 Autosomal Recessive Polycystic 9.2.5.7 Acquired Renal Cystic Disease 9.3 Congenital Abnormalities of the PUJ 9.3.1 Hydronephrosis 9.3.2 PUJ Obstruction 9.3.2.1 Surgical Correction 9.3.3 Congenital Abnormalities of the Ureter 9.3.3.1 Duplex System 9.3.3.2 Ectopic Ureter 9.3.3.3 Ureterocele 9.3.3.4 Megaureter 9.3.3.5 Retrocaval Ureter 9.3.3.6 Congenital Abnormalities of VUJ References Chapter 10 Hydronephrosis 10.1 Definition 10.2 Incidence 10.3 Pathophysiology 10.3.1 Macroscopic Changes in Upper Urinary Tract Obstruction 10.3.2 Microscopic Changes in Upper Urinary Tract Obstruction 10.3.3 Ureteric Function in Upper Urinary Tract Obstruction 10.3.4 Renal Haemodynamics, Glomerular Filtration Rate and Intrarenal Pressure in Upper Urinary Tract Obstruction 10.3.5 Effect on Tubular Function 10.3.6 Effects of Obstruction on the Kidney 10.3.7 Postobstructive Renal Recovery and Diuresis 10.3.8 General Clinical Features 10.4 Diagnostic Imaging 10.4.1 Ultrasound 10.4.2 Nuclear Medicine Isotopic Renograms 10.4.3 Computer Tomography Urography (CTU) 10.4.4 Magnetic Resonance Urography (MRU) 10.4.5 Pyelography (Either Retrograde or Antegrade) 10.4.6 The Whitaker Test 10.4.6.1 Results 10.5 Complications of Hydronephrosis 10.5.1 Infection 10.5.2 Stones 10.5.3 Trauma 10.5.4 Hypertension 10.6 Management (General Principles) 10.7 Perinatal Hydronephrosis 10.8 Pelviureteric Junction Obstruction 10.8.1 Pathogenesis 10.8.2 Natural History and Presentation 10.8.3 Investigations 10.8.4 Management 10.8.5 Pyeloplasty 10.8.5.1 Procedure 10.8.5.2 Results 10.8.6 Endopyelotomy 10.8.7 Nephrectomy in Hydronephrosis 10.9 Retrocaval Ureter 10.10 Duplication Anomalies, Ectopic Ureter, and Ureteroceles 10.10.1 Definitions and Incidences 10.10.2 Management 10.11 VUR 10.11.1 Aetiology 10.11.2 Management 10.11.3 Primary VUR 10.11.4 Surgery 10.12 Megaureter 10.13 Ureteral Strictures 10.13.1 Pathophysiology References Chapter 11 Kidney and Ureter Trauma 11.1 Kidney Injuries 11.1.1 Types of Injuries 11.1.2 Classification of Kidney Injury 11.1.3 Diagnosis and Investigations 11.1.3.1 History and Initial Assessment 11.1.3.2 Blood Tests 11.1.3.3 Imaging 11.1.4 Management 11.1.4.1 Nonsurgical Management 11.1.5 Surgical Exploration: Options 11.1.6 Role of Angiogram and Embolisation 11.1.7 Renal Injury in the Patient with Polytrauma 11.1.7.1 Iatrogenic Renal Injuries 11.1.7.2 Complications of Renal Trauma 11.2 Ureteral Injuries 11.2.1 Causes of Ureteric Injuries 11.2.2 Classification of Ureteral Injuries 11.2.3 Clinical Features 11.2.4 Investigations 11.2.5 Management of Ureteral Injuries 11.2.5.1 Retrograde Study and JJ Stent Insertion 11.2.5.2 Other Operative Repair Options 11.2.6 Operative Repair Options for Ureteral Injury 11.2.6.1 Boari–Ockerblad Flap 11.2.6.2 Psoas Hitch 11.2.6.3 Transureteroureteric Anastomosis 11.2.6.4 Ileal Loop Interposition References Chapter 12 Kidney and Ureter Inflammation 12.1 Medical Inflammatory Conditions of the Kidney 12.1.1 Glomerulonephritides (Table 12.1) 12.1.2 Tubulointerstitial (Table 12.2) 12.2 Acute Surgical Inflammatory Conditions of the Kidney 12.2.1 Pyelonephritis 12.2.1.1 Aetiology and Risk Factors 12.2.1.2 Clinical Presentation 12.2.1.3 Pathophysiology of Sepsis 12.2.1.4 Investigation 12.2.1.5 Management 12.2.2 Renal Abscess 12.2.2.1 Aetiology and Risk Factors 12.2.2.2 Clinical Presentation 12.2.2.3 Investigation 12.2.2.4 Management 12.2.3 Pyonephrosis or Infected Hydronephrosis 12.2.3.1 Aetiology and Risk Factors 12.2.3.2 Clinical Presentation 12.2.3.3 Investigation 12.2.3.4 Management 12.2.4 Perinephric Abscess 12.2.5 Emphysematous Pyelonephritis (EPN) 12.2.5.1 Aetiology and Risk Factors 12.2.5.2 Clinical Presentation 12.2.5.3 Investigation 12.2.5.4 Management 12.2.5.5 Prognosis 12.2.6 Xanthogranulomatous pyelonephritis (XPN) 12.2.6.1 Pathophysiology, Aetiology, and Risk Factors 12.2.6.2 Clinical Presentation 12.2.6.3 Investigation 12.2.6.4 Management 12.2.6.5 Complications and Prognosis 12.3 Chronic Surgical Inflammatory Conditions of the Kidney 12.3.1 Tuberculosis 12.3.1.1 Introduction 12.3.1.2 Aetiology and Risk Factors 12.3.1.3 Clinical Presentation 12.3.1.4 Investigation 12.3.1.5 Management 12.3.2 Ureteric TB 12.3.2.1 Complications and Prognosis 12.3.3 Chronic Pyelonephritis 12.3.3.1 Introduction 12.3.3.2 Clinical Presentation 12.3.3.3 Investigations 12.3.3.4 Management 12.3.3.5 Complications and Prognosis 12.3.4 Papillary Necrosis 12.4 Other Inflammatory Conditions of the Kidney 12.4.1 Malakoplakia 12.4.2 Hydatid Disease 12.4.3 Fungal Infections 12.4.4 Brucellosis 12.4.5 Chyluria and Filariasis 12.4.5.1 Pathophysiology 12.4.5.2 Investigations 12.4.5.3 Treatment 12.5 Inflammatory Conditions of the Ureters 12.5.1 Retroperitoneal Fibrosis 12.5.1.1 Introduction 12.5.1.2 Aetiology and Pathophysiology 12.5.1.3 Clinical Presentation 12.5.1.4 Investigations 12.5.1.5 Management 12.5.2 Ureteric Endometriosis 12.5.3 Amyloidosis 12.5.4 Pelvic Lipomatosis References Chapter 13 Kidney and Ureter Neoplasm 13.1 Kidney Neoplasms 13.1.1 Malignant Renal Masses 13.1.1.1 Renal Cell Carcinoma 13.1.1.2 Von Hippel–Lindau Disease 13.1.1.3 Familial Papillary RCC or Hereditary Papillary RCC 13.1.1.4 Hereditary Leiomyomatosis 13.1.1.5 Birt-Hogg-Dubé Syndrome 13.1.1.6 Histological Types 13.1.1.7 Clinical Features 13.1.1.8 Diagnosis 13.1.1.9 Staging and Grading 13.1.1.10 Prognosis 13.1.1.11 Treatment 13.1.1.12 Other Types of Malignant Renal Masses 13.2 Benign Renal Masses 13.2.1 Renal Cysts 13.2.2 Oncocytoma 13.2.3 Angiomyolipomas 13.2.4 Renal Cortical Adenoma 13.2.5 Metanephric Adenoma 13.2.6 Cystic Nephroma and Mixed Epithelial or Stromal Tumour 13.2.7 Leiomyoma 13.2.8 Columns of Bertin 13.2.9 Expert Opinion 13.3 Ureter and Renal Pelvis Neoplasms 13.3.1 Incidence 13.3.2 Aetiology 13.3.2.1 Modifiable Risk Factors 13.3.2.2 Nonmodifiable Risk Factors 13.3.3 Histology Types 13.3.3.1 Benign 13.3.3.2 Malignant 13.3.4 Clinical Features 13.3.5 Diagnosis 13.3.5.1 Urine Cytology 13.3.5.2 Radiological Investigations 13.3.5.3 Diagnostic Endoscopy and Histological Evaluation 13.3.6 Staging and Grading 13.3.7 Prognostic Factors 13.3.8 Treatment 13.3.8.1 Surgery 13.3.8.2 Adjuvant Treatment 13.3.8.3 Treatment of Advanced Disease 13.3.8.4 Follow-Up References Chapter 14 Kidney and Ureter Calculi 14.1 Epidemiology 14.2 Pathophysiology 14.3 Formation of Calculi in the Kidney 14.3.1 Concretions 14.3.2 Papillary Necrosis 14.3.3 Medullary Sponge Kidney 14.3.4 Hydronephrosis and Hydrocalyx 14.3.5 Recumbency Stones 14.4 Common Types of Urinary Stones 14.4.1 Calcium Stones 14.4.2 Struvite Stones or Infections Stones 14.4.3 Uric Acid Stones 14.4.4 Cystine Stones 14.4.5 Drug-Induced Stones 14.5 Clinical Features 14.5.1 Kidney 14.5.2 Ureter 14.5.3 Bladder 14.6 Complications of Stones 14.6.1 Renal Stones 14.6.2 Stones in the Ureter 14.6.3 Stones in the Bladder 14.6.4 Stones in the Prostate 14.6.5 Stones in the Urethra 14.7 Investigations 14.7.1 Is the Shadow Really a Stone? 14.7.2 What Trouble Is the Stone Causing? 14.7.3 Renal Function 14.7.4 Treatment Planning 14.7.4.1 Follow-Up and Radiation Safety 14.8 Investigations for Metabolic Stone Disease 14.8.1 The First Episode or a Patient with Low-Risk Symptoms 14.8.2 The Recurrent Stone Former or a Patient with High-Risk Symptoms 14.9 Medical Management of Stones 14.9.1 Management 14.9.1.1 Acute Management 14.10 Surgery for Stones 14.10.1 Observational and Conservative Management 14.10.2 Medical Expulsive Therapy (MET) 14.10.2.1 Choice of Drug 14.10.3 SWL 14.10.3.1 Lithotripter 14.10.3.2 Imaging System 14.10.3.3 Shock Wave Generator 14.10.3.4 URS (Rigid/Flexible) 14.10.3.5 Percutaneous Nephrolithotomy 14.10.3.6 Laparoscopy, Robotic, and Open Stone Surgery References Chapter 15 Kidney and Ureter Vascular Disorders 15.1 Congenital Anomalies of the Renal Vessels 15.1.1 Haemangioma 15.1.2 Renal Segmental Hypoplasia (Ask–Upmark Kidney) 15.2 Renal Artery Disorders 15.2.1 Traumatic Lesions of the Renal Artery 15.2.2 Renal Artery Stenosis 15.2.3 Renal Artery Dysplasia 15.2.4 Renal Artery Aneurysm 15.2.5 Renal Infarction 15.2.6 Pathogenesis of Renal Hypertension 15.3 Disorders of the Renal Veins 15.3.1 Congenital Anomalies 15.3.2 Renal Vein Thrombosis References Chapter 16 The Adrenal Glands 16.1 Principles of Endocrine Surgery 16.2 Anatomy 16.2.1 Surgical Relations 16.2.2 Arterial Supply 16.2.3 Nerve Supply 16.3 Physiology 16.3.1 Cortex 16.3.2 Medulla 16.4 Pathology 16.4.1 Pathology of the Adrenal Cortex 16.4.1.1 Hypofunction 16.4.1.2 Hyperfunction 16.4.1.3 Nonfunctioning Pathology 16.5 Pathology of the Adrenal Medulla 16.5.1 Hypofunction 16.5.2 Non-function 16.5.2.1 Adrenal Neuroblastoma 16.5.3 Hyperfunction 16.5.3.1 Pheochromocytoma and Paraganglioma 16.5.4 Imaging and Localisation 16.5.4.1 CT and MRI 16.5.4.2 Management 16.5.4.3 Treatment 16.6 Congenital Disorders of the Adrenals 16.7 Trauma 16.8 Inflammation References Part III Chapter 17 Bladder and Urethra Structure and Function 17.1 Anatomy 17.1.1 Gross Anatomy of the Bladder 17.1.2 Bladder Wall 17.1.3 Trigone, Ureters, and Bladder Neck 17.1.4 Arteries, Veins, and Lymphatics 17.1.5 Female Urethra 17.1.6 Male Urethra 17.1.7 Neuroanatomy Relevant to the Bladder and Urethra 17.2 Physiology 17.2.1 Overview 17.2.2 Neurological Control of Urine Storage and Micturition 17.2.2.1 Smooth Muscle Contraction in the Urinary Tract References Chapter 18 Bladder Congenital Anomalies 18.1 Embryology [1, 2] 18.2 Exstrophy-Epispadias Complex 18.2.1 Bladder Exstrophy 18.2.1.1 Management 18.2.1.2 Surgery 18.2.2 Epispadias 18.2.2.1 Surgery of Epispadias 18.2.2.2 Continence Surgery 18.2.3 Cloacal Exstrophy 18.3 Urachal Anomalies 18.3.1 Patent Urachus 18.3.2 Urachal Sinus 18.3.3 Urachal Cyst 18.4 Bladder Diverticula 18.4.1 Bladder ‘Ears’ 18.4.2 Megacystis 18.5 Disorders of Development of the Sacrum 18.5.1 Sacral Agenesis 18.5.2 Presacral Dermoid 18.6 UTI in Children [91, 92] 18.6.1 Classification 18.6.2 History and Examination 18.6.3 Investigations 18.6.3.1 Urine Collection and Interpretation [91] 18.6.3.2 Clinical Differentiation between Acute Pyelonephritis (Upper Urinary Tract Infection) and Cystitis (Lower Urinary Tract Infection) [91] 18.6.4 Radiological Investigation (Table 18.4) 18.6.4.1 Ultrasonography 18.6.4.2 Nuclear Medical Scans 18.6.4.3 Cystourethrography 18.6.4.4 Urodynamics 18.6.5 Management 18.6.5.1 Acute Management [91–93] 18.6.5.2 Prevention of Recurrence 18.6.5.3 Antibiotic Prophylaxis 18.6.6 Follow-Up [91] 18.6.7 Information and Advice for Children, Young People, and Parents or Caregivers 18.6.7.1 Lower Urinary Tract Symptoms in Children 18.6.7.2 Nocturnal Enuresis [94] References Chapter 19 Bladder Trauma 19.1 Bladder Injuries 19.1.1 Classification of Bladder Injuries 19.1.1.1 Traumatic Bladder Injury 19.1.1.2 Iatrogenic 19.1.2 Diagnosis and Investigations 19.1.2.1 Clinical Assessment 19.1.2.2 Blood Tests 19.1.2.3 Imaging 19.1.3 Management 19.1.3.1 Conservative Management 19.1.3.2 Surgical Management 19.1.4 Variant Injuries 19.1.4.1 Silent Rupture of the Bladder 19.1.4.2 Catheter Trauma 19.1.4.3 Cather Balloon Rupture 19.1.4.4 Gunshot Wounds References Chapter 20 Bladder Inflammation 20.1 Introduction and Definitions 20.2 Acute Cystitis or Lower UTI 20.2.1 Bacterial Cystitis 20.2.1.1 Pathogenesis 20.2.1.2 Clinical Features 20.2.1.3 Investigations 20.2.1.4 Management 20.2.1.5 Recurrent UTI 20.2.1.6 UTI in Children 20.2.2 Viral Cystitis 20.2.3 Noninfectious Cystitis 20.2.3.1 Chemical Cystitis 20.2.3.2 Radiation Cystitis 20.2.4 Chronic Bacterial Cystitis 20.2.5 Cystitis Follicularis 20.2.6 Cystitis Cystica 20.2.7 Eosinophilic Cystitis 20.2.8 Malakoplakia 20.2.9 Emphysematous Cystitis 20.2.10 Alkaline-Encrusted Cystitis 20.3 Chronic Interstitial Cystitis and Bladder Pain Syndrome 20.4 Tuberculosis 20.5 Parasitic Infections 20.5.1 Introduction 20.5.2 Schistosomiasis 20.5.2.1 Introduction 20.5.2.2 Aetiology 20.5.2.3 Pathology and Pathophysiology 20.5.2.4 Clinical Features 20.5.2.5 Investigations 20.5.2.6 Management 20.5.2.7 Bilharzial Cancer of the Bladder 20.5.2.8 Other Complications of Schistosomiasis 20.6 Amoebiasis 20.7 Worm Infestations 20.8 Catfish References Chapter 21 Bladder Neoplasm 21.1 Bladder Neoplasm 21.1.1 Incidence 21.1.2 Aetiology 21.1.2.1 Modifiable Risk Factors 21.1.2.2 Nonmodifiable Risk Factors 21.1.3 Clinical Features 21.1.4 Investigations 21.1.4.1 Urine Cytology 21.1.4.2 Urinary Biomarkers 21.1.4.3 Imaging 21.1.4.4 Cystoscopy 21.1.5 Transurethral Resection 21.1.5.1 Complications 21.2 Field Biopsies 21.3 Pathology 21.3.1 Benign Lesions of the Bladder 21.4 Malignant Tumours of the Bladder 21.4.1 Primary Tumours 21.4.1.1 Urothelial Neoplasm 21.4.1.2 Urothelial Dysplasia 21.4.1.3 Carcinoma in Situ 21.4.1.4 Papillary and Solid Urothelial Carcinoma 21.4.1.5 Nonurothelial Tumours 21.4.2 Secondary Bladder Tumours 21.5 Grading of Transitional Cell Carcinoma 21.5.1 Grading ISUP/WHO2004 21.6 Staging of Bladder Tumours 21.7 Risk Stratification after Transurethral Resection of Bladder Tumour 21.8 Treatment of Transitional Cell Carcinoma 21.8.1 Non-Muscle–Invasive Bladder Cancer 21.8.2 Intravesical Chemotherapy (Mitomycin) 21.8.2.1 Contraindications: Bleeding or Bladder Perforation 21.8.2.2 Adjuvant Therapy with Bacillus Calmette-Guérin 21.8.3 Photodynamic Therapy 21.8.4 Adjuvant Intravesical Chemotherapy 21.8.4.1 Failure of Intravesical Therapy 21.8.5 Follow-up of NMIBC 21.9 Muscle-Invasive Bladder Cancer 21.9.1 Spread of Bladder Tumours 21.9.1.1 Direct Spread 21.9.1.2 Urine-Borne Spread 21.9.1.3 Lymphatic Permeation 21.9.1.4 Haematogenous Spread 21.9.1.5 Prostatic Route 21.9.2 Investigations in MIBC 21.9.3 Management of Localised Muscle-Invasive Bladder Cancer (MIBC) (T2 disease + − T3a) 21.9.4 Perioperative Chemotherapy 21.9.4.1 Neoadjuvant Chemotherapy 21.9.4.2 Adjuvant Chemotherapy 21.10 Recurrence and Follow‐up of MIBC 21.11 Management of Locally Advanced MIBC (T3b/T4) and Metastatic Disease (N1 or M1) 21.12 Bladder Cancer Variants 21.12.1 Squamous Cell Carcinoma 21.12.2 Carcinoma of the Urachus 21.12.3 Cancer in a Diverticulum References Chapter 22 Urinary Diversion 22.1 Urinary Diversions 22.1.1 History 22.1.2 Nephrostomy 22.1.3 Suprapubic Cystostomy 22.1.3.1 Indications of SPC Insertion [5] 22.1.3.2 Contraindications of SPC Insertion [5] 22.1.3.3 Complications [5] 22.2 Bladder Urinary Diversion 22.2.1 Incontinent Urinary Diversion 22.2.1.1 Cutaneous Ureterostomy 22.2.1.2 Intestinal Conduit 22.2.2 Continent Urinary Diversions 22.2.2.1 Orthotopic Bladder Substitution (Neobladder) 22.2.2.2 Continent Pouches and Bladder Augmentation 22.2.2.3 Natural Evacuation Urinary Diversion 22.3 Functional Follow-Up 22.4 Quality of Life Urinary Diversion after Cystectomy References Chapter 23 Bladder Disorder of Function 23.1 Introduction 23.1.1 Physio-Anatomy 23.1.2 Definitions 23.1.3 History Taking and Physical Examination 23.2 Investigating Bladder Function 23.2.1 Initial Investigations 23.2.1.1 Specialised Investigations 23.3 Disorders of Function 23.3.1 Primary Storage Dysfunction 23.3.1.1 Overactive Bladder Syndrome 23.3.1.2 Urinary Incontinence (UI) 23.3.1.3 Painful Bladder Syndrome 23.3.1.4 Nocturia or Nocturnal Polyuria 23.3.1.5 Increased Bladder Sensation 23.3.1.6 Reduced or Absent Bladder Sensation 23.3.2 Primary Voiding Dysfunction 23.3.2.1 Detrusor Underactivity and Detrusor Failure 23.3.3 Functional Obstruction (Urinary Retention in Women) 23.3.3.1 Definition, Incidence, and Aetiology 23.3.3.2 History, Examination, and Common or Important Differential Diagnoses 23.3.3.3 Investigations 23.3.3.4 Treatment 23.4 Urethral Disorders 23.4.1 Urethral Diverticulum 23.4.1.1 Definition and Aetiology 23.4.1.2 Incidence 23.4.1.3 History and Examination 23.4.1.4 Investigation 23.4.1.5 Treatment 23.4.2 Urethral Pain Syndrome 23.4.2.1 Definition and Incidence 23.4.2.2 Aetiology 23.4.2.3 History, Examination, and Common or Important Differential Diagnoses 23.4.2.4 Investigations 23.4.2.5 Treatment 23.4.3 Invasive Urodynamics in the Assessment of Male BOO 23.4.3.1 Aetiology 23.4.3.2 History, Examination, and Common or Important Differential Diagnoses 23.4.3.3 Investigations: The Role of Invasive Urodynamics 23.4.4 Bladder Disorders Secondary to Other Disease Processes 23.4.4.1 Neurogenic Bladder Dysfunction, Including DSD 23.4.4.2 Pelvic Organ Prolapse References Chapter 24 Fistulae and Sinuses 24.1 Principles and Definitions 24.2 Pathophysiology 24.3 General Complications 24.4 Organ-Specific Fistulae 24.4.1 Kidney 24.4.2 Ureter 24.4.2.1 Ureteral-Arterial Fistulae 24.4.2.2 Ureterovaginal Fistula 24.4.2.3 Ureteroenteric Fistula 24.4.2.4 Ureterocutaneous Fistula 24.4.3 Bladder 24.4.3.1 Colovesical Fistula 24.4.3.2 Vesicovaginal Fistula 24.4.3.3 Vesicouterine Fistula (Youssef’s Syndrome) 24.4.3.4 Vesicocutaneous Fistula 24.4.4 Urethra 24.4.4.1 Rectourethral Fistula 24.4.4.2 Urethrovaginal Fistula 24.4.4.3 Urethrocutaneous Fistula 24.4.5 Sinuses References Part IV Chapter 25 Prostate Structure and Function 25.1 Comparative Anatomy 25.2 Maturation of the Prostate 25.3 Anatomy of the Prostate 25.3.1 Topographical Anatomy 25.3.2 Capsule of the Prostate 25.3.2.1 Anatomical Capsule 25.3.2.2 Capsule at ‘Simple’ Open Prostatectomy for Benign Prostate Hyperplasia (Millin Prostatectomy) 25.3.2.3 Capsule at Transurethral Resection 25.3.3 Arteries 25.3.4 Veins 25.3.5 Lymphatics 25.3.6 Nerves 25.4 Prostate Physiology 25.4.1 Function 25.4.2 Prostate-Specific Antigen 25.4.3 Prostatic Acid Phosphatase 25.4.4 Emission and Ejaculation 25.4.5 Prostate and Sphincters References Chapter 26 Prostate Inflammation 26.1 Classification of Prostatitis 26.1.1 Category I: Acute Bacterial Prostatitis 26.1.2 Category II: Chronic Bacterial Prostatitis 26.1.3 Category IIIa: Inflammatory Chronic Prostatitis/Chronic Pelvic Pain Syndrome and Category IIIb: Non-inflammatory 26.1.4 Category IV: Asymptomatic Inflammatory (Histological) Prostati 26.2 Investigations 26.2.1 Microbial Localisation 26.3 Imaging 26.4 Serum Prostate Specific Antigen 26.5 Histology 26.6 Treatment Options 26.6.1 Antibiotics 26.6.2 Tamsulosin and Finasteride 26.6.3 Pain Relief 26.6.4 Pentosan Polysulphate 26.6.5 Other Therapies 26.7 Upoint Phenotypic Classification of CP/CPPS 26.8 Surgical Options 26.9 Heat Therapies 26.10 Prostate Tuberculosis 26.11 Summary References Chapter 27 Prostate Benign Prostatic Hyperplasia 27.1 Nomenclature 27.2 Aetiology 27.2.1 Hormonal Factors 27.2.1.1 Role of Androgens 27.2.1.2 Role of Oestrogen 27.2.2 Stromal/Epithelial Interaction (Embryonic Reawakening) and Growth Factors 27.2.3 Genetic Factors 27.2.4 Role of Inflammatory Pathways 27.2.5 Other Causative Relationships 27.3 Pathology of BPH 27.3.1 Response to Obstruction 27.4 Complications of BPH 27.4.1 Chronic Retention of Urine 27.5 Epidemiology and Natural History of BPH 27.6 Investigations 27.6.1 History 27.6.2 Examination 27.6.3 Objective Assessment of LUTS 27.6.4 Urinalysis 27.6.5 Frequency or Voiding Volume Chart 27.6.6 Blood Tests 27.6.7 Other Investigations 27.7 Management 27.7.1 Watchful Waiting 27.7.2 Medical Management 27.7.2.1 Acute Urinary Retention and Its Management 27.7.2.2 Chronic Urinary Retention 27.7.2.3 Polyuria and Nocturnal Polyuria 27.8 Surgical Management 27.8.1 Technique 27.8.2 Objectives 27.8.3 Steps of the Operation 27.8.4 Postoperative Management 27.8.5 Complications [103, 104–107] 27.8.5.1 Early Complications References Chapter 28 Prostate Neoplasm 28.1 Epidemiology 28.2 Aetiology 28.2.1 Nonmodifiable Risk Factors 28.2.1.1 Age 28.2.1.2 Family History and Genetics 28.2.1.3 Race 28.2.2 Modifiable Risk Factors 28.2.2.1 Diet 28.2.2.2 Body Mass Index 28.2.2.3 Hormonal Factors 28.2.2.4 Drugs 28.3 Clinical Features 28.4 Prognosis 28.5 Investigations 28.5.1 Prostate-Specific Antigen 28.5.2 PSA Density 28.5.3 PSA Doubling Time 28.5.4 PSA Velocity 28.5.5 Digital Rectal Examination 28.5.6 Diagnostic Investigations 28.5.6.1 Transrectal Ultrasound Imaging 28.5.6.2 TRUS-Guided Biopsy 28.5.6.3 Repeat and Saturation Biopsy 28.5.6.4 Incidental Finding in Positron Emission Tomography–Computed Tomography 28.5.7 Staging Investigations 28.5.7.1 Local Staging 28.5.7.2 Lymph Node Staging 28.6 Pathology, Histopathology, and Molecular Pathology 28.6.1 Histopathology 28.6.1.1 Prostatic Intraepithelial Neoplasia 28.6.1.2 Atypical Small Acinar Proliferation 28.6.1.3 Adenocarcinoma 28.6.1.4 Other PCa 28.6.2 Grading 28.6.2.1 Gleason Grading 28.6.2.2 Translating to an Updated Grading System 28.6.2.3 Concordance of Biopsy 28.6.2.4 Grading after Therapy 28.6.3 Immunostains 28.6.3.1 Basal Cell–Associated Markers 28.6.3.2 Prostate Cancer–Associated Markers 28.6.3.3 Prostate Lineage–Specific Markers 28.6.4 Molecular Pathology 28.6.4.1 Potential Molecular Markers 28.7 Management, Treatments, and Patient Selection 28.7.1 Low-Risk Localised Prostate Cancer 28.7.1.1 Active Surveillance and Watchful Waiting 28.7.2 High-Risk Localised PCa 28.7.2.1 Radical Prostatectomy 28.7.3 Role of (Pelvic) Lymph Node Dissection 28.7.4 Radical Radiotherapy 28.7.4.1 External Beam Radiotherapy 28.7.4.2 Stereotactic Ablative Radiotherapy 28.7.4.3 Brachytherapy 28.7.5 Locally Advanced PCa 28.7.5.1 Radical External Beam Radiotherapy 28.7.5.2 Radical Prostatectomy 28.7.6 Recurrence after Curative Intent Treatment 28.7.6.1 Adjuvant versus Salvage Treatment 28.7.6.2 Salvage Radiotherapy Post-Radical Prostatectomy 28.7.6.3 Salvage Therapy Postradical Radiotherapy (Androgen-Deprivation Therapy or Salvage Prostatectomy) 28.7.6.4 Metastatic Prostate Cancer 28.8 Androgen-Deprivation Therapy 28.8.1 Anti-Androgens 28.8.2 Dual and Combined Androgen Blockade 28.8.3 Second-Generation Anti-Androgens: Enzalutamide and Abiraterone 28.8.4 Androgen-Deprivation Therapy Options 28.8.4.1 First-Line Androgen-Deprivation Therapy 28.8.5 Second-Line Androgen-Deprivation Therapy 28.8.5.1 Dual and Combined Androgen Blockade 28.8.6 Third-Line Androgen-Deprivation Therapy 28.8.6.1 Oestrogenic Therapy 28.8.6.2 Combined and Upfront Chemohormonal Therapy 28.9 Castration-Resistant Prostate Cancer 28.9.1 Castration-Resistant Nonmetastatic Prostate Cancer 28.9.2 Metastatic Castration-Resistant Prostate Cancer 28.9.3 Palliative Management of Metastatic Castration Resistant Prostate Cancer 28.9.3.1 Palliative Radiotherapy 28.9.3.2 Emergency Management 28.9.3.3 Supportive Care 28.10 The Role of TURP for Voiding Symptoms Associated with PCa 28.11 Controversies, Cutting-Edge Developments, and Hot Topics 28.11.1 PSA Screening 28.11.2 Biopsy Approach: Transrectal versus Transperineal 28.11.3 Role of Multiparametric MRI and MRI Fusion Biopsy 28.11.4 MRI-Guided Biopsy 28.11.5 Emerging Biomarkers 28.11.5.1 Serum Biomarkers 28.11.5.2 Urine Biomarkers 28.11.5.3 Whole Blood Biomarkers 28.11.5.4 Circulating Tumour DNA 28.11.5.5 Exosomes 28.11.5.6 Tissue Biomarkers 28.11.5.7 Genetic Mutations and Gene Expression Profiling 28.11.5.8 Focal Therapies References Part V Chapter 29 Penis and Urethra Structure and Penis 29.1 Anatomy and Physiology 29.1.1 Comparative Anatomy 29.1.2 Topographical Anatomy 29.2 The Penis 29.2.1 Blood Supply and Lymphatic Drainage 29.2.1.1 Arterial Supply 29.2.1.2 Venous Drainage 29.2.1.3 Lymphatics 29.2.2 Nerve Supply 29.2.2.1 Autonomic 29.2.2.2 Somatic Afferent and Efferent Nerves 29.3 The Scrotum 29.3.1 Fascia 29.3.2 Blood Supply and Lymphatic Drainage 29.3.2.1 Arterial Supply 29.3.2.2 Venous Drainage 29.3.2.3 Lymphatic Drainage 29.3.2.4 Nerves 29.4 The Urethra 29.4.1 Male Urethra 29.4.2 Female Urethra 29.5 Erection 29.6 Function of the Scrotum 29.6.1 Physiology of the Urethra References Chapter 30 Penis and Urethra and Prostate Congenital Anomalies 30.1 Foreskin 30.1.1 Embryology and Function Review 30.1.2 Phimosis 30.1.3 Circumcision 30.1.3.1 Medical Indications of Circumcision 30.1.3.2 Alternatives to Circumcision 30.1.3.3 Technique of Circumcision 30.1.4 Paraphimosis 30.1.5 Infections and Inflammation of the Foreskin 30.1.5.1 Lichen Sclerosis or Balanitis Xerotica Obliterans 30.1.5.2 Buried Penis and Congenital Megaprepuce 30.2 Hypospadias 30.2.1 Embryology 30.2.2 Incidence, Risk Factors, and Associations 30.2.3 Classification [41, 42] 30.2.4 Diagnosis 30.2.5 Management 30.2.5.1 Penile Curvature 30.2.5.2 Urethral Reconstruction 30.2.5.3 Complications 30.3 Primary Epispadias 30.3.1 Embryology 30.3.2 Types 30.3.3 Presentation 30.3.4 Management 30.4 Posterior Urethral Valves 30.4.1 Embryology 30.4.2 Classification 30.4.3 Clinical Presentation and Diagnosis 30.4.4 Management 30.4.5 Prognosis and Long-Term Follow-Up 30.4.6 Indicators of Renal Outcome in PUV [57] 30.4.6.1 Indictors of a Poor Renal Outcome 30.4.6.2 Indicators of Good Renal Outcome 30.4.6.3 Role of Foetal Interventions 30.5 Prostatic Utricle 30.6 Syringocele 30.7 Anterior Urethral Valves 30.8 Urethral Duplication 30.9 Urethral Anomalies in Anorectal Malformations 30.9.1 Disorders of Sex Development 30.9.1.1 Nomenclature and Classification [65] 30.9.1.2 Female Subject to Masculinization (46 XX DSD) 30.9.1.3 Congenital Adrenal Hyperplasia (46 XX DSD) 30.9.1.4 Males with Undermasculinisation 30.9.1.5 46, XY DSD 30.9.1.6 Mosaicism (XO/XY) 30.9.1.7 Klinefelter Syndrome (47 XXY) 30.9.1.8 Turner Syndrome (45 XO) 30.9.1.9 Diagnosis 30.10 Interesting Terminologies 30.10.1 Megalourethra 30.10.2 Aphallia 30.10.3 Microphallus 30.10.4 Penile Duplication 30.10.5 Penile Torsion References Chapter 31 Penis and Urethra Trauma 31.1 Penis and Scrotum 31.1.1 Trauma to Foreskin 31.1.2 Penile Trauma 31.1.2.1 Fracture of the Penis 31.1.2.2 Amputation of the Penis 31.1.2.3 Battery Burn 31.1.2.4 Trauma Causing Priapism or Impotence 31.1.3 Scrotal Trauma 31.1.3.1 Lacerations and Avulsions of the Scrotum 31.1.3.2 Blunt Trauma 31.2 Urethral Trauma 31.2.1 Introduction 31.2.2 Noniatrogenic Urethral Injury 31.2.2.1 Male Posterior Urethral Injury 31.2.2.2 Male Anterior Urethral Injury 31.2.2.3 Female Urethral Injury 31.2.2.4 Urethral Injury in Children 31.2.2.5 Clinical Presentation 31.2.2.6 Investigation 31.2.2.7 Management 31.2.3 Iatrogenic References Chapter 32 Penis and Urethra Inflammation 32.1 Urethral Inflammation 32.1.1 Urethritis 32.1.1.1 Infective Urethritis 32.2 Penile Inflammation 32.2.1 Balanitis 32.2.1.1 Introduction 32.2.1.2 Acute balanitis 32.2.1.3 Chronic balanitis 32.2.1.4 Zoon Balanitis 32.2.1.5 Lichen Planus 32.3 Other Urethro-Peno-Scrotal Pathologies 32.3.1 Fournier’s Gangrene 32.3.1.1 Introduction 32.3.1.2 Aetiology 32.3.1.3 Pathogenesis 32.3.1.4 Presentation 32.3.1.5 Management 32.3.2 Periurethral Abscess 32.3.3 Condyloma Acuminata (Genital Warts) 32.3.3.1 Aetiology 32.3.3.2 Presentation 32.3.3.3 Treatment 32.3.4 Chancroid 32.3.5 Granuloma Inguinale 32.3.6 Paraphimosis 32.3.6.1 Conservative Measures 32.4 Stricture Disease of the Urethra 32.4.1 Definition and Incidence 32.4.2 Anatomy 32.4.3 Aetiology 32.4.4 Signs and Symptoms 32.4.5 Complications of Urethral Stricture 32.4.6 Investigations 32.4.7 Treatment 32.4.7.1 Urethral Dilation 32.4.7.2 Direct Vision Internal Urethrotomy 32.4.7.3 Urethroplasty 32.4.7.4 Penile Urethra 32.4.8 Female Urethral Stricture 32.5 Pelvic Fracture Urethral Injury 32.5.1 Incidence 32.5.2 Aetiology 32.5.3 Mechanism 32.5.4 Assessment and Acute Management 32.5.5 Surgical Considerations 32.5.6 Complications References Chapter 33 Penis and Urethra Neoplasm 33.1 Penile Neoplasm 33.1.1 Benign Penile Lesions 33.1.2 Malignant Neoplasm of the Penis 33.1.2.1 Incidence and Prevalence 33.1.2.2 Aetiology and Risk Factors 33.1.2.3 Clinical Features 33.1.2.4 Diagnosis and Investigations 33.1.2.5 Histopathology 33.1.2.6 Staging 33.1.2.7 Management 33.2 Lymph Node Disease 33.2.1 Management of Lymph Nodes 33.2.1.1 Clinically Impalpable Lymph Nodes 33.2.1.2 Clinically Palpable Inguinal Lymph Nodes 33.2.2 Management of the Fixed Nodal Mass and Nodes with Extranodal Spread 33.2.2.1 Pelvic Lymphadenopathy 33.2.2.2 Distant Metastases 33.2.2.3 Follow-Up 33.3 Urethral Neoplasm 33.3.1 Benign Urethral Neoplasms 33.3.2 Malignant Urethral Neoplasms 33.3.3 Aetiology 33.3.4 Clinical Features 33.3.5 Staging and Grading 33.3.6 Prognosis 33.3.7 Treatment 33.3.7.1 Localised Disease 33.3.7.2 Locally Advanced Disease 33.3.7.3 Metastatic Disease 33.3.7.4 Follow-Up References Chapter 34 Penis and Urethra Disorders of Function 34.1 Erectile Dysfunction 34.1.1 Pathophysiology 34.1.1.1 Psychogenic Erectile Dysfunction 34.1.1.2 Organic Erectile Dysfunction 34.1.2 Assessment 34.1.2.1 Clinical History 34.1.2.2 Physical Examination 34.1.3 Investigations 34.1.3.1 General Investigations 34.1.3.2 Specialised Investigations 34.1.4 Management 34.1.4.1 First-Line Medical Therapy 34.1.4.2 Second-Line Therapy 34.1.4.3 Vacuum Erection Device 34.1.4.4 Third-line Therapy: Penile Prostheses 34.2 Premature Ejaculation 34.2.1 Aetiology 34.2.1.1 Biological Factors 34.2.1.2 Psychological Factors 34.2.2 Classification of Premature Ejaculation 34.2.3 Assessment 34.2.4 Management 34.2.4.1 Behavioural and Nonpharmacologic Therapy 34.2.4.2 Pharmacologic Therapy 34.3 Retrograde Ejaculation 34.3.1 Aetiology 34.3.2 Presentation 34.3.3 Diagnosis 34.3.4 Management 34.4 Anejaculation 34.4.1 Aetiology 34.4.2 Anorgasmia 34.4.3 Management 34.5 Priapism 34.5.1 Pathophysiology 34.5.2 Aetiology and Classification 34.5.2.1 Low-Flow (Ischemic) Priapism 34.5.2.2 High-Flow (Nonischemic) Priapism 34.5.2.3 Stuttering (Recurrent or Intermittent) Priapism 34.5.3 Assessment 34.5.4 Management 34.5.4.1 Management of Low-Flow Priapism 34.5.4.2 Management of High-Flow Priapism 34.5.4.3 Management of Stuttering Priapism 34.6 Peyronie Disease 34.6.1 Congenital Peyronie Disease 34.6.2 Acquired Peyronie Disease 34.6.3 Aetiology 34.6.4 Pathogenesis and Natural History 34.6.5 Clinical Features 34.6.6 Management 34.6.6.1 Nonoperative Treatment 34.6.6.2 Surgical Treatment 34.7 Late Onset Hypogonadism 34.7.1 Definition 34.7.2 Pathophysiology 34.7.3 Aetiology 34.7.4 Risk Factors Increasing the Likelihood of LoH 34.7.5 Clinical Features 34.7.6 Diagnosis 34.7.7 Treatment [31, 33, 35, 36] References Part VI Chapter 35 Testes Structure and Function 35.1 Comparative Anatomy 35.2 Topographical Anatomy 35.2.1 Testes 35.2.2 Coverings of the Testicle 35.3 Blood Supply and Lymphatic Drainage 35.3.1 Arterial Supply 35.3.2 Venous Drainage 35.3.3 Lymphatic Drainage 35.3.4 Nerve Supply 35.4 Epididymis 35.4.1 Blood Supply 35.5 Vas Deferens 35.5.1 Blood Supply 35.6 Seminal Vesicle 35.7 Verumontanum 35.8 Spermatic Cord 35.9 Testicular Physiology 35.9.1 Hypothalamic-Pituitary-Gonadal Axis (Figure 35.10) 35.9.2 Leydig Cells 35.9.3 Sertoli Cells 35.9.4 Production and Action of Testosterone 35.9.5 Spermatogenesis References Chapter 36 Testes Congenital and Childhood Anomalies 36.1 Congenital Anomalies of the Testis 36.1.1 Embryology Review 36.1.2 Undescended Testis (Cryptorchidism) 36.1.2.1 Incidence 36.1.2.2 Classification 36.1.2.3 Ascending Testis 36.1.3 Aetiology 36.1.4 Pathophysiology 36.1.4.1 Fertility 36.1.4.2 Malignancy 36.1.4.3 Other 36.1.5 Diagnosis 36.1.6 Treatment 36.1.6.1 Hormonal Treatment 36.1.6.2 Surgical Treatment 36.1.7 Agenesis or Absence of the Testis 36.1.8 Polyorchism 36.2 Inguinoscrotal Masses 36.2.1 Embryology Review 36.2.2 Indirect Inguinal Hernia and Hydrocele 36.2.2.1 Clinical Presentation 36.2.2.2 Management 36.2.3 Varicocele 36.2.3.1 Clinical Presentation 36.2.3.2 Diagnosis 36.2.3.3 Treatment 36.3 The Acute Scrotum 36.3.1 Testicular Torsion 36.3.1.1 Presentation 36.3.1.2 Diagnosis 36.3.1.3 Treatment 36.3.1.4 Outcome 36.3.2 Perinatal Testicular Torsion 36.3.3 Torsion of the Appendix Testis or Appendix Epididymis 36.3.3.1 Presentation 36.3.3.2 Diagnosis 36.3.3.3 Treatment 36.3.4 Epididymitis, Orchitis, and Epididymo-Orchitis 36.3.4.1 Presentation 36.3.4.2 Diagnosis 36.3.4.3 Treatment 36.3.5 Idiopathic Scrotal Oedema 36.3.6 Testicular Trauma References Chapter 37 Testes Trauma and Inflammation 37.1 Testicular Trauma 37.1.1 Investigations 37.1.2 Management 37.1.2.1 Testicular Rupture 37.1.2.2 Haematocele 37.1.2.3 Testicular Dislocation 37.1.2.4 Cord Disruption 37.2 Inflammatory Diseases of the Testicle 37.2.1 Acute Inflammation 37.2.1.1 Viral Orchitis 37.2.1.2 Bacterial Epididymo-orchitis / Orchitis 37.2.2 Clinical Features 37.2.3 Investigations 37.2.4 Differential Diagnosis 37.2.4.1 Testicular Torsion 37.2.4.2 Idiopathic Scrotal Oedema 37.2.5 Treatment 37.2.6 Complications 37.3 Chronic Inflammation 37.3.1 Tuberculous Epididymitis 37.3.1.1 Complications 37.3.2 Granulomatous Epididymitis 37.3.3 Granulomatous Orchitis 37.3.4 Bilharzial Epididymitis 37.3.5 Candidial Epididymo-Orchitis 37.3.6 Malacoplakia 37.3.7 Actinomycosis 37.3.8 Brucellosis 37.3.9 Behçet’s Disease 37.3.10 Syphilis 37.3.11 Other Causes of Epididymo-Orchitis 37.4 Treatment 37.4.1 Conservative Therapy 37.4.2 Medical Therapy 37.4.3 Surgical Therapy 37.4.3.1 Epididymectomy References Chapter 38 Testes Benign Swelling 38.1 Hydrocele 38.1.1 Aetiology 38.1.1.1 Congenital Hydrocele 38.1.1.2 Primary or Idiopathic Hydrocele 38.1.1.3 Secondary Hydrocele 38.1.2 Clinical Features 38.1.3 Investigations 38.1.4 Treatment 38.1.5 Operations for Hydrocele 38.1.6 Complications 38.2 Epididymal Cyst 38.2.1 Operative Technique 38.3 Benign Testicular Cyst 38.4 Testicular Torsion 38.4.1 Extravaginal 38.4.2 Intravaginal 38.4.3 Clinical Features 38.4.4 Investigation 38.4.5 Differential Diagnosis 38.4.6 Treatment 38.4.6.1 Scrotal Exploration 38.4.7 Torsion of a Testicular Appendage 38.5 Polyorchidism 38.6 Varicocele 38.6.1 Clinical Features 38.6.2 Investigations 38.6.3 Treatment 38.6.3.1 Embolisation 38.6.3.2 Surgical Ligation 38.6.3.3 Retroperitoneal Ligation 38.6.3.4 Subinguinal ligation 38.7 Orchialgia 38.8 Nux Amatoris References Chapter 39 Testes Neoplasm 39.1 History 39.2 Incidence 39.3 Basic Embryology 39.4 Aetiology and Risk Factors 39.5 Clinical Features 39.6 Diagnosis 39.6.1 Imaging 39.6.2 Serum Tumour Markers 39.6.3 Surgical Excision 39.6.3.1 The Surgical Approach to Radical Orchiectomy 39.6.4 Retroperitoneal Lymph Node Dissection 39.6.4.1 Pathological Classification 39.7 Staging 39.8 Method of Spread 39.9 Prognosis 39.10 Treatment 39.10.1 Localised Disease (Stage I: T1-4N0M0) 39.10.1.1 Seminomas 39.10.1.2 How Chemotherapy Works 39.10.1.3 NSCGTs 39.10.2 Metastatic Disease (Stages II and III) 39.10.2.1 Seminomas 39.10.2.2 NSGCTs 39.10.2.3 Residual or Refractory Disease or Relapse after Primary Treatment 39.10.3 Other Considerations in the Treatment of These Patients 39.10.4 Follow-Up 39.11 Nongerm Cell Tumours 39.11.1 Sex Cord or Gonadal Stromal Tumours 39.11.2 Leydig Cell Tumours 39.11.3 Sertoli Cell Tumours (SCT) 39.11.4 Granulosa Cell Tumours (GrCT) 39.12 Tumours Containing Both Germ Cell and Sex Cord or Gonadal Stromal Elements: Gonadoblastoma 39.13 Other Tumours of the Testis 39.13.1 Sarcomas 39.13.2 Lymphoma 39.14 Tumours of the Paratesticular Structures References Chapter 40 Male Infertility 40.1 Incidence 40.2 Definitions 40.3 History and Examination 40.4 Aetiology 40.4.1 Functional Causes of Male Infertility 40.4.1.1 Genetic Causes 40.4.1.2 Hormonal Causes 40.4.1.3 Varicocele 40.4.1.4 Undescended Testes 40.4.1.5 Testicular Tumours 40.4.1.6 Exposure to Gonadotoxins 40.4.1.7 Systemic Diseases 40.4.1.8 Iatrogenic Factors 40.4.1.9 Orchitis 40.4.1.10 Infection of the Accessory Glands 40.4.1.11 Testicular Torsion 40.4.1.12 Testicular Trauma 40.4.1.13 Autoimmune Infertility 40.4.2 Genital Tract Obstruction 40.4.2.1 Intratesticular Obstruction 40.4.2.2 Epididymal Obstruction 40.4.2.3 Congenital Absence of the Vas Deferens 40.4.2.4 Vasal Obstruction 40.4.2.5 Ejaculatory Duct Obstruction 40.4.3 Coital Infertility 40.4.3.1 Erectile Dysfunction 40.4.3.2 Premature Ejaculation 40.4.3.3 Penile Deformities 40.4.3.4 Anejaculation 40.4.3.5 Retrograde Ejaculation 40.5 Investigations for Male Infertility 40.5.1 Semen Analysis 40.5.1.1 Antisperm Antibodies 40.5.1.2 Semen Culture 40.5.1.3 Seminal ROS levels 40.5.1.4 DNA Fragmentation 40.5.2 Male Reproductive Hormonal Profile 40.5.3 Male Reproductive Genetic Profile 40.5.4 Postorgasmic Urine Analysis 40.5.5 Imaging 40.5.5.1 Scrotal Ultrasound and Colour Doppler 40.5.5.2 Transrectal Ultrasound Scan 40.6 Testis Biopsy 40.7 Treatment of Male Infertility 40.7.1 Obstructive Azoospermia 40.7.1.1 Ejaculatory Duct Obstruction 40.7.1.2 Vasal Obstruction 40.7.1.3 Congenital Bilateral Absence of the Vas Deferens 40.7.1.4 Epididymal Obstruction 40.7.1.5 Intratesticular Obstruction 40.7.2 Nonobstructive Azoospermia 40.7.3 Surgical Sperm Retrieval Techniques 40.7.3.1 PESA 40.7.3.2 MESA 40.7.3.3 TESA 40.7.3.4 TESE 40.8 Assisted Conception Techniques 40.9 Varicocele Repair 40.10 Medical Treatment of Male Infertility 40.10.1 Endocrine Treatments 40.10.1.1 Gonadotrophin-Releasing Hormone 40.10.1.2 Gonadotrophins 40.10.1.3 Dopamine Agonists 40.10.1.4 Aromatase Inhibitors 40.10.1.5 Selective Oestrogen Receptor Modulators 40.10.1.6 Treatment of Chronic Prostato-vesiculitis 40.10.1.7 Treatment with Antioxidants References Chapter 41 Vasectomy and Seminal Vesicle Disorders 41.1 Seminal Vesicles 41.1.1 Anatomy and Physiology 41.1.2 Topographical Anatomy 41.1.3 Congenital Anomalies 41.1.4 Infection 41.1.5 Neoplasms 41.1.6 Degenerative Diseases 41.1.7 Investigations 41.1.8 Imaging 41.1.9 Semen Analysis 41.1.10 Surgical Approach to the Seminal Vesicles 41.2 Vasectomy 41.2.1 Counselling 41.2.2 Examination 41.2.3 Shaving 41.2.4 Anaesthesia 41.2.5 Choice of Incision 41.2.6 Operative Technique 41.2.7 Complications 41.2.7.1 Early Complications 41.2.7.2 Later Complications 41.2.8 Postoperative Semen Analysis 41.2.9 Vasectomy Reversal References Index EULA