Ebook Principles and practice of urology (2/E): Part 1

Part 1 book “Principles and practice of urology” has contents: Milestone of urology, investigations of urological disease, presentation of urological disease, emergency urology, genitourinary infection, general urology, pediatric urology, neurourology,… and other contents.

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Principles and Practice

of Urology

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MA SalamMBBS FCPS FICSFormer Chairman and Professor of Uro-oncology

Department of UrologyBangabandhu Sheikh Mujib Medical University

Dhaka, BangladeshandFounder President and CEOUrology and Transplant Foundation of Bangladesh45/1, Green Road, Dhaka, Bangladesh

Foreword

Mahesh R Desai

JAYPEE BROTHERS MEdicAl PuBliSHERS (P) lTd

New Delhi • London • Philadelphia • Panama

Principles and Practice

of

Urology Second Edition

Volume 1

®

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Jaypee Brothers Medical Publishers (P) Ltd.

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Jaypee Brothers Medical Publishers (P) Ltd.

4838/24, Ansari Road, Daryaganj

New Delhi 110 002, India

Inquiries for bulk sales may be solicited at: jaypee@jaypeebrothers.com

This book has been published in good faith that the contents provided by the contributors contained herein are original, and

is intended for educational purposes only While every effort is made to ensure accuracy of information, the publisher and the editor specifically disclaim any damage, liability, or loss incurred, directly or indirectly, from the use or application of any of the contents of this work If not specifically stated, all figures and tables are courtesy of the editor Where appropriate, the readers should consult with a specialist or contact the manufacturer of the drug or device.

Principles and Practice of Urology (Volume 1)

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®

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Dedicated to

All peoples suffering from urological diseases.

My lovely wife Jharna, my children Probal, Samudra,

Daughter-in-law Julee, my parents and all my other family members,

who missed me for many sweet moments.

My academic family members, the faculties, the postgraduate students, trainees and residents of urology and staffs related to urology and other subjects for their active assistance.

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Abdul Mannan Khan

Professor of Urology

Bangladesh Institute of Research and

Rehabilitation for Diabetes

Endocrine and Metabolic

Disorders Hospital

Dhaka, Bangladesh

ABM Golam Rabbani

Assistant Professor of Urology

Rajshahi Medical College Hospital

Rajshahi, Bangladesh

Afiquor Rahman

Head and Professor of Urology

Ad-din Medical College Hospital

Maghbazar, Dhaka, Bangladesh

AFM Kamal Uddin

Consultant Radiation Oncologist

Consultant, Female Urologist

Jaslok Hospital, Mumbai

Maharashtra, India

AKM Anwarul Islam

Chairman and Professor of Urology

AKM Zamanul Islam Bhuiyan

Director and Professor of Urology National Institute of Kidney Diseases and Urology

Sher-E-Bangla Nagar Dhaka, Bangladesh

Ali Akbor

Professor of Urology Retired Major General Holy Family Medical College Hospital Easkaton, Dhaka, Bangladesh

ATM Aman Ullah

Associate Professor of Neurourology Department of Urology

Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh

BK Dastur

Urological Surgeon Medical Research Centre Bombay Hospital Trust Mumbai, Maharashtra, India

Christopher Cheng

Professor and Chairman Department of Urology Singapore General Hospital Outram Road, Singapore

Emdadul Haque

Assistant Professor of Pediatric Urology National Institute of Kidney Diseases and Urology

Sher-E-Bangla Nagar Dhaka, Bangladesh Presently Urology Fellow Central Coast Health Service NSW, Australia

Farakh Khan

Former Professor of Urology Medical College, Lahore, Pakistan

Fazal Naser

SS Medical College Hospital Sher-E-Bangla Nagar, Dhaka, Bangladesh

Ganesh Gopalakrishnan

Senior Consultant of Urology Coimbatore, Tamil Nadu, India Former Head and Professor Department of Urology Christian Medical College Vellore, Tamil Nadu, India

Golam Mowla Chowdhury

Associate Professor of Urology Department of Urology Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh

Harun-ur-Rashid

Former Chairman and Professor

of Nephrology Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh Chairman of Kidney Foundation Mirpur, Dhaka, Bangladesh

Hemant B Tongaonkar

Head and Professor Department of Urologic Oncology Tata Memorial Hospital, Parel Mumbai, Maharashtra, India

Ishtiak Al Mamoon

Doctoral Researcher Department of Electronic System Engineering Malaysia Japan International Institute of Technology (MJIIT)

University Technology Malaysia Kuala Lumpur, Malaysia

Isteaq Ahmed Shameem

Associate Professor of Pediatric Urology Bangabandhu Sheikh Mujib

Medical University Dhaka, Bangladesh

Contributors

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Principles and Practice of Urology

Labaid Specialized Hospital

Dhanmondi, Dhaka, Bangladesh

Kazi Rafiqul Abedin

National Institute of Kidney Diseases

and Urology, Dhaka, Bangladesh

Khoorsheed Jahan Maula

Former Head and Associate Professor

of Gyne-oncology

Senior Consultant of Gyne-oncology

Comfort Nursing Home

Dhaka, Bangladesh

KM Monwarul Karim

Chittagong Medical College Hospital

Chittagong, Bangladesh

K Sasidharan

Kasturba Medical College

Manipal Academy of Higher Education

Manipal, Karnataka, India

KT Foo

Professor

Department of Urology

Singapore General Hospital

Outram Road, Singapore

Laila Anjuman Banu

Professor of Molecular Biology and

President, Endourological Society

Past President, Societe Internationale

d’urologie

Medical Director

Muljibhai Patel Urological Hospital

Nadiad, Kheda, Gujarat, India

Makarand V Khochikar

Consultant Uro-oncologist Siddhi Vinayak Ganapati Hospital Miraj, Sangli, Maharashtra, India

MA Salam

Former Chairman and Professor of Uro-oncology

Department of Urology Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh and

Founder President and CEO Urology and Transplant Foundation of Bangladesh, 45/1, Green Road Dhaka, Bangladesh

Matiur Rahman

Founder Professor and Senior Consultant of Nephrology Comfort Nursing Home

Dhaka, Bangladesh

Matiur Rahman

Professor Department of Pediatric Surgery Bangabandhu Sheikh Mujib Medical University

Md Faisal Islam

Assistant Professor of Urology National Institute of Kidney Diseases and Urology

Sher-E-Bangla Nagar Dhaka, Bangladesh

Md Fakhrul Islam

Chairman and Professor of Urology Bangladesh Medical College Hospital Dhanmondi, Dhaka, Bangladesh

Dhaka, Bangladesh

Md Waliul Islam Maruf

Associate Professor of Urology National Institute of Kidney Diseases and Urology

Dhaka, Bangladesh

M Hasan Akther

Consultant Urologist Sylhet Women’s Medical College Sylhet, Bangladesh

Mir Ehteshamul Haque

Assistant Professor of Uro-oncology National Institute of Cancer Research and Hospital, Mohakhali, Dhaka, Bangladesh

Mirza M Hasan

Head and Professor of Urology Department of Urology Bangladesh Institute of Research and Rehabilitation for Diabetes Endocrine and Metabolic Disorders

Dhaka, Bangladesh

Mohammad Shafiqur Rahman

Associate Professor of Uro-oncology Department of Urology

Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh

Mohsin Uddin

Associate Professor of Urology Khwaja Yunus Ali Medical College and Hospital, Sirajganj, Bangladesh

Moudud Hossain Alamgir

Head Department of Surgery Dinapur Medical College Dinapur, Bangladesh

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Contributors ix

Mozzam Hossain

Professor of Pediatric Nephrology

Bangabandhu Sheikh Mujib

New York Medical College

New York, USA

Muhammad Rafiqul Alam

Chairman and Professor of Nephrology

Bangabandhu Sheikh Mujib

Medical University

Dhaka, Bangladesh

NI Bhuiyan

Bangladesh Medical College

Dhanmondi, Dhaka, Bangladesh

Nitin S Kekre

Christian Medical College and Hospital

Vellore, Tamil Nadu, India

NP Gupta

Former Chairman and Professor

All India Institute of Medical Sciences

New Delhi, India

Consultant Urologist

Medanta: The Medicity

Gurgaon, Haryana, India

National Institute of Kidney Diseases

Pranashish Saha

Assistant Professor of Urology National Institute of Kidney Diseases and Urology (NIKDU), Sher-E-Bangla Nagar Dhaka, Bangladesh

Pranjal R Modi

Professor and Head Department of Urology and Transplantation Surgery Institute of Kidney Diseases and Research Center

Institute of Transplantation Sciences Civil Hospital Campus, Asarwa Ahmedabad, Gujarat, India

Prem Nath Dogra

Chairman and Professor Department of Urology All India Institute of Medical Sciences New Delhi, India

Prem Raj Gyawali

Associate Professor and Chairman Department of Urology and Transplant Grande International Hospital

Dhapasi, Kathmandu Nepal and Tribhuvan University Teaching Hospital

Maharajganj, Nepal

Promode Ranjan Singh

Head and Associate Professor of Urology MAG Osmani Medical College and Hospital Sylhet, Bangladesh

Rajeev Kumar

Professor Department of Urology All India Institute of Medical Sciences New Delhi, India

Ravindra Bhalchandra Sabnis

Chairman Department of Urology Muljibhai Patel Urological Hospital Nadiad, Kheda, Gujarat, India

Sajid Hasan

Professor of Uro-oncology Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh

SA Khan

Professor of Urology Popular Medical College Hospital Dhanmondi, Dhaka, Bangladesh

SAM Golam Kibria

Professor and Former Chairman Department of Urology Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh

Sanjay Kulkarni

Honorable Associate Professor of Urology KEM Hospital, Pune, Maharashtra, India Chief Urologist

Kulkarni Endosurgery Institute Pune, Maharashtra, India

Shadrul Alam

Associate Professor Rangpur Medical College Hospital Rangpur, Bangladesh

Dhaka, Bangladesh

Shahadat Hossain

Associate Professor Department of Pediatric Surgery Bangabandhu Sheikh Mujib Medical University

Dhaka, Bangladesh

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x

Shahidul Islam Sugom

Rangpur Medical College Hospital

Rangpur, Bangladesh

Shailesh Puntambekar

Consultant Cancer Surgeon and

Head of Galaxy Care Laparoscopy Institute

Center for Advanced Laparoscopy and

Robotic Surgery, Pune, Maharashtra, India

Shailesh Raina

Consultant Urologist

Lilavati Hospital and Research Center

Bandra Reclamation

Mumbai, Maharashtra, India

Shankar Kumar Biswas

Associate Professor Center for Nuclear Medicine and Ultrasound Dhaka Medical College Hospital

Dhaka, Bangladesh

Shivaji Basu

Chief Urologist Kidney Institute Rashbehari Avenue and Fortis Hospitals Kolkata, West Bengal, India

Shohrab Hossain

Assistant Professor of Urology MAG Osmani Medical College Hospital Sylhet, Bangladesh

SM Mahbub Alam

Head and Professor of Urology Dhaka Medical College Hospital Dhaka, Bangladesh

Zahid Hossain Bhuiyan

Professor of Urology Bangladesh Medical College Hospital Dhanmondi, Dhaka, Bangladesh

Zahirul Islam Miah

Senior Consultant of Urology Faridpur Diabetic Hospital Faridpur, Bangladesh

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Urology has made many advances and progress in the past few decades primarily as a result of significant progress in understanding the pathophysiology of urological diseases and introduction of truly minimally invasive surgery

Principles and Practice of Urology mainly addresses young trainees in urology and is written by experts in this field who

are also experienced teachers It is hoped that the book will be helpful to prevent the younger surgeons and trainees from the mistakes and common complications

There are many good books on urology in the world market, but Principles and Practice of Urology has been developed

to address the urological issues that are commonly met in the developing part of the world and the management has been tailored to obtain the best success with the limited resources I sincerely hope that the specialists, trainees and students of Asian, African and Latin American developing countries will find the book more useful than others

For the beginners, four big ‘Cs’ is strongly recommended: Climb, Communicate, Confess, and Comply These are the basic actions for any pilot in distress and they may just be as applicable for any medical professional facing a difficult situation that may help to overcome

Traditionally, as before, the book is emphasizing the principle of art of urologic surgery from the standpoint of open, laparoscopic, endourologic, microsurgical, prosthetic, tissue engineering, genetic engineering and robotic approaches An internationally reputed set of contributions has graced us with their wisdom

Mahesh R Desai

MS FRCS (Lond) FRCS (Edin) President, Endourological Society Past President, Societe Internationale d’urologie

Medical Director Muljibhai Patel Urological Hospital Nadiad, Kheda, Gujarat, India

Foreword

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The second edition of Principles and Practice of Urology has been extensively revised, reviewed and improved, including the

format and presentation The book is aimed mainly at urologists, general surgeons, nephrologists, gynecologists, residents and postgraduate medical students of different disciplines, senior medical students and trainee medical professionals of relevant specialties

The first edition was reasonably limited and published in USA by Brown Walker, Florida, USA and in Bangladesh It was

so instantly well received that further reprints were required within the first year of its appearance There was a pressing request for further emphasis on graphic and pictorial representations of the various surgical techniques

I hope that you will find the second edition of the book as an informative and a good reference to refresh your knowledge

in the field of urology Specialists of all fields will also find the book is a quick review of the current developments in this field and a reminder of important features of different conditions in their field of interest

The main objective of the book is to enable the reader to have a quick review of the subject and can update him with current relevant information I believe that the readers will find the value and enjoyment when reading the textbook, either

as a ‘cover-to-cover’ read or a particular section that applies to their area of interest I hope very much that you will enjoy reading the book

I keep six honest serving men (They taught me all I knew);

Their names are What and Why and When and How and Where and Who.

—Rudyard Kipling (The Elephant’s Child, in the Just-So Stories, 1902)

Clinical knowledge is based on the three components: meticulous observation, detailed recording, and an understanding and analyzing the clinical data relevant to the clinical situation to overcome the clinical problem The first two come with apprenticeship and the last one with personal inquisitive reading It is the last component that is the basis for the book Perfect practice of urology will develop ‘Urological Artists’ in urological community and their output will result a state-of-the-art outcome Some of these artistic urologists will emerge as philosopher urologists This ‘Philosopher Urologists’ will be able to make change over the existing method of treatment or they may set a new horizon for the others Some of the talented urologists of the past is introduced in the book There are many ‘Urologist Philosophers’ among us now and

we hope that there will be many in future The objective of the book is to build more and more ‘Urological Artists’ if not

‘Philosopher Urologists’ This is true for all branches of medical sciences

The text is didactic and should provide the basis for further reading from journals or more detailed review papers The book is aimed at residents and urological specialists at all levels of training in urology

I am indebted to the outstanding panel of national and international contributors for their efforts and outstanding work toward the production of the book I am most grateful to all the contributors who covered their topics expertly and clearly

I am fortunate to have so many eminent colleagues contributing to the book

I remain grateful to all my friends and colleagues for their enthusiasm and active help for the preparation, processing the manuscripts and proofreading Dr Mohsin Uddin, Dr Ibrahim Kaiser and my secretary Mr Roney worked very hard for the book and deserve special thanks

I remain very much grateful to the superb job done by all the outstanding staffs at M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, and their close cooperation, for the task of the difficult publication

MA Salam

Preface to the Second Edition

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Why another textbook on urology? There is always a universal demand of appropriate good book in any subject Despite the existence of numerous monographs on urology, there remains a desperate need for a book emphasizing the scientific background and principles of patient care for the student trainees and reinforcing such concepts for the practicing urologists in the developing world.

Urology today is a subject of growing importance and the need for a comprehensive text on the basic principle of general urology was deeply felt by the author, by the trainees and students All medical writings are practically rewritings plus the recent advances, but they are presented in a different format suitable for the specific class of readers or users Despite many good books available, an appropriate book is needed in between the users and the advanced texts

Principles and Practice of Urology is neither intended to replace the existing textbook nor it can provide the minute

details contained in scientific journals Instead, the author expects that the book will serve as a rapid review of clinically important informations for the postgraduate students, residents, trainees, practicing surgeons and urologists It is also expected to provide much of the updated information in an identifiable and understandable format

The purpose of composing this text is to guide and assist the students, residents, trainee doctors of urology and this book may be used as a text or reference book by the senior students in medical colleges A space is kept on the left side of the page for the reader to record his personal note This book is expected to be helpful for the consultant general surgeons who are working in a hospital where there are no urologists

I do solicit additional modifications, corrections and criticism which may be addressed to me

MA Salam

Preface to the First Edition

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I would like to thank Shri Jitendar P Vij (Group Chairman), Mr Ankit Vij (Managing Director), Mr Tarun Duneja (Director-Publishing) and Mr KK Raman (Production Manager) of M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for their continued support and encouragement to complete this incredible work I wish to thank Ms Samina Khan (PA to Director-Publishing), who provides continuous communication about the corrections, placements, editing, etc She helped immeasurably to stay on time, on the job, and on focus The final result has been inestimably improved by her efforts I wish to extend my sincere thanks to Mr Nitin Huria and Mr Amitoj Singh, who were intimately connected to the preparation of the book The medical artists deserve a special thanks for their excellent works I am very much concerned about the background staffs of the publisher who escapes the notice of everyone my special thanks to them Finally and most importantly, I would like to thank my family, who missed me long time during the period of many years Without their support and sacrifice, I would have never been able to dedicate the time and effort required for the publication of this innovative venture.

Acknowledgments

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Section 1: MileStone of Urology

MA Salam

Prehistoric Urology in Different Parts of World 4; Middle Ages to the Eighteenth Century 6;

Nineteenth Century 7; Great Mind and Philosophers in Urology 22

Section 2: PreSentation of Urological DiSeaSe

MA Salam, Mohammad Shafiqur Rahman

Art of History Taking (Careful Listening to the Patient is an Art) 33; Smoking and Urological Disease 41;

Drug Allergies 41; Physical Examination of Urological Patients 42

Section 3: inveStigationS of Urological DiSeaSe

MA Salam, MA Wahab

Urinalysis 47; Laboratory Tests 51; Hormonal Studies in Urine 55

AKM Zamanul Islam Bhuiyan

Radiology Techniques 57; Radiation Exposure Hazard 57; Contrast Media 58; Anaphylactic Reactions 59;

Nephrotoxicity 59; Cardiovascular Toxicity 59; Radiological Investigations for Urological Patients 59

5 Intravenous Urography and Contrast Study of Lower Urinary Tract 64

AKM Anwarul Islam, Zahirul Islam Miah

Procedure 64; Basic Techniques and Principle of Intravenous Urography 64;

Contraindications of Intravenous Urography 65; Indications of Intravenous Urography 65;

Advantages of Intravenous Urography 65; Limitations of Intravenous Urography 65;

The Future of the Intravenous Urography 65; Antegrade Urography and Retrograde Urography 66;

Voiding Cystourethrogram or Micturating Cystourethrogram 66; Cavernosography and Cavernosometry 67

6 Principles of the Ultrasound and its Applications in Urology 68

MA Salam

Physics of Medical Ultrasound 68; Ultrasound Imaging Methods 68; Intraoperative Use of Ultrasound 72;

Renal Ultrasound 72; Bladder Ultrasound 76; Ultrasound Imaging of Prostate Prelude 78;

Determination of Prostate Volume with Ultrasound 78; Benign Prostatic Hypertrophy 78; Prostate Cancer 78;

Prostatic Infection 79; Techniques of Ultrasound Study of Prostate 79; Perineal Approach 79;

Biopsy of Prostate 80; Seminal Vesicle Cyst 80; Ultrasound Scan of Urethra 80;

Scrotal Ultrasonography 81; Doppler Principles 82

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xx

Abdul Mannan Khan

Physics of MRI 92; Recent Advances of MRI 92; Basic Principles of MRI 93; Clinical Applications of MRI 94;

Advantages of MRI 97; Contraindications of MRI 97; Magnetic Resonance Urography 97;

Advantages and Disadvantages of MRI 98

SA Khan, Shankar Kumar Biswas

Radioisotope Measurement of Glomerular Filtration Rate 101;

Radionuclide Techniques Available for Studying the Function of the Renal Tract 102

10 Abdominal Positron Emission Tomography or Computed Tomography 108

Ali Akbor

Radioisotopes 108; Cyclotron Centers 109; Indications of PET/CT 110; Transitional Cell Carcinoma 110;

Renal Cell Carcinoma 110; Testicular Malignancies 110

Section 4: eMergency Urology

MA Wahab, MA Salam

Presentation 115; Diagnosis 115; Differential Diagnoses of Flank Pain 118; Management 121

SAM Golam Kibria, AKM Anwarul Islam

Etiology 126; History 127; Physical Examination 127; Management 127; Complications of Relieving Obstruction 128

Shivaji Basu

Principle of Treatment of Acute Upper Genitourinary Tract Injury 130;

Upper Tract Trauma (Renal Injuries and Ureteral Injuries) 130

MA Salam, AKM Khurshidul Alam

Etiology of Ureteric Trauma 137; Clinical Diagnosis 137; Radiological Diagnosis 137;

Classification of Ureteric Injury 138; Management of Ureteric Injury 138

MA Salam, Md Sayedul Islam

Causes of Lower Genitourinary Tract Trauma 142; Pathophysiology of Lower Genitourinary Tract Trauma 142;

History 142; Physical Examination 143; Prehospital Care 144;

Principle of Management of Lower Urinary Tract Trauma 144

K Sasidharan

Diagnosis of Bladder Injury 145; Cause and Pathophysiology of Bladder Injury 145;

Classification of Bladder Injury 146; Computed Tomography Scan 148;

Cystography 148; Excretory Urography 148; Management of Bladder Rupture 148;

Penetrating Bladder Injury 148; Postoperative Care 148; Follow-up 149

Sanjay Kulkarni, MA Salam

Applied Anatomy and Pathophysiology 150; Etiology 151; Mechanism of Injury 151; Clinical Assessment 152;

Classification of Urethral Injury 152; Presentation 152; Work-up 152; Anterior Urethral Injuries 153;

Posterior Urethral Injuries 153; Female Urethral Injuries 154; Complications of Urethral Injury 154;

Outcome and Prognosis 154

MA Salam, SM Mahbub Alam

Common Injuries of Penis 156; Strangulation of Penis by Metallic or Nonmetallic Ring 160

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Contents xxi

MA Salam, Mirza M Hasan

Mechanism of Injury 162; Etiology 162; Presentation 162; Physical Examination 162; Imaging of Scrotal Injury 163;

General Management of Scrotal Injury 163; Complications of Scrotal Injury 164; Indications for Scrotal Exploration 164;

Follow-up 164; Complications of Testicular Injury 164

Section 5: genitoUrinary infection

Jahangir Kabir

Pathogenesis of Urinary Tract Infection 169; Bacteriological Evidence of Infection 169; Pathophysiology 170;

Prevalence of Urinary Tract Infection 171; Risk, Mortality and Morbidity 171;

The Natural History of Urinary Tract Infection 171; Physical Examination 172; Differential Diagnoses 172;

Work-up of Urinary Tract Infection 172; Treatment 174; Prevention of Urinary Tract Infection 177; Complications 177

Etiology 179; Pathogenesis and Risk Factors 179; Signs and Symptoms 179; Classification 179;

Diagnosis 180; Schedule of Investigation 183; Treatment 183; Management 184

Rajeev Kumar

Definition 187; Pathophysiology of Sepsis 188; Clinical Manifestation of Urosepsis 188; Treatment 189;

Focus on the Management of the Septic Patient 190; Focus on Outcome from Sepsis 191

AKM Khurshidul Alam

Diagnosis 193; Classification Systems 194; Treatment 195

Golam Mowla Chowdhury

Incidence and Prevalence 197; Pathogenesis and Pathology 197; Diagnosis 197; Treatment 198

25 Perioperative Antibacterial Prophylaxis in Urology 200

AKM Khurshidul Alam, MA Salam

Aims and Objectives 200; Risk Factors 201; Principles of Antibiotic Prophylaxis 201;

Regimens for Prophylaxis for Different Procedures 202

Mohammad Shafiqur Rahman

Definitions 204; Risk Factors 204; Diagnosis 205;

Antimicrobial Strategy for the Treatment of Urinary Tract Infection 205; Management of Specific Urological Infection 206;

Recommendations on Recurrent Urinary Tract Infection 210; Conclusion and Future 210

Pranashish Saha, Kazi Rafiqul Abedin

Factors Responsible for the Sexually Transmitted Diseases 212; Nongonococcal Urethritis 212; Gonorrhea 213;

Syphilis 213; Chancroid 214; Lymphogranuloma Venereum 214; Granuloma Inguinale 214;

Condyloma Acuminata or Venereal Warts 214; Genital Herpes Simplex 215;

Acquired Immunodeficiency Syndrome 215; Prevention of Sexually Transmitted Diseases 215

NP Gupta, Md Sayedul Islam

Incidence 217; Etiopathogenesis 217; Pathogenesis 218; Presentation 218; Diagnosis 218; Treatment 218;

Follow-up of Genitourinary Tuberculosis 219; Management of Drug Resistant Tuberculosis 219

New Concepts 221; Interstitial Cystitis Symptoms 221; Diagnosis 221;

Potassium Test (Persons Test) 222; Management 222

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xxii

Section 6: general Urology

30 Advances of Radiation Oncology and its Applications to Urology 227

AFM Kamal Uddin, Afiquor Rahman

Kidney Tumors 227; Role of Radiotherapy in Renal Cell Carcinoma 227;

Carcinoma of Bladder 229; Carcinoma Prostate 231

Dev Narayan Dutta

Important Features 236; Imaging Techniques of CyberKnife 236;

Other Stereotactic Systems 238; Clinical Uses 238

AFM Kamal Uddin, MA Salam

Gene Therapeutic Strategies 239; The Future of Gene Therapy 241

Prem Nath Dogra, Prabhjot Singh

History 243; Basic Principle of Laser 243; Components of Laser System 244; Laser Tissue Interaction 245;

Types of Lasers 246; Laser Applications in Urology 249; Lasers in Laparoscopy 255

34 Image-guided Percutaneous Treatment of Genitourinary Cancer 259

MA Salam, Md Faisal Islam

Indications 259; Patient Preparation/Anesthesia 260; Image Guidance 260;

Image-guided Tumor Ablation Modalities 261;

Complications of Percutaneous Ablation 263; Follow-up 264

35 Stem Cells Research and its Practical Applications 266

Laila Anjuman Banu, Mohsin Uddin

Embryonic Stem Cell Lines 266; Adult Stem Cells 266; Amniotic Stem Cells 267;

Induced Pluripotent Stem Cells 267; Practical Applications of Stem Cell Research 269

Ishtiak Al Mamoon, MA Salam

History of Telemedicine 270; Types of Telemedicine 270

Mohsin Uddin, MA Salam

Principles of Tissue Engineering 273; Application of Stem Cells 274;

Urological Applications of Tissue Engineering 274;

Generation of Histocompatible Tissues Using Nuclear Transplantation 275

MA Salam, Nitin S Kekre

Statutory Regulations for Operating Theater Complex 277; Different Zones of Operation Theater Complex 277;

Sub Areas 278; Types of Operating Theater Complex 279;

Principles to be Taken into Consideration While Planning an Operating Theater (Physical/Architecture) 279;

Usual Disadvantages of Existing OT in Old Hospitals 282; Operating Theater for the Urologist 283

39 High Frequency Electrosurgical Apparatus (Diathermy Equipment) 284

Prem Raj Gyawali

Technical Concept 284; Tissue Effect 284; Unipolar Diathermy 285; Bipolar Diathermy 286;

Urological Applications 286; Mode of Action 287; Quality of High-frequency Current (Modulation) 288;

Factors Influencing the Therapeutic Effect 288; Safety Considerations 288

Jahangir Kabir, MA Salam

Mechanism of Tissue Coagulation 292;

Use of the Ultrasonic Surgical Shears or Harmonic Scalpel 292

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Contents xxiii

41 Tissue Fusion System (LigaSure) and Evident Microwave Ablation System 294

Pranjal R Modi

The Evident™ Microwave Ablation System 295

42 Principles of Intravesical Chemotherapy and Immunotherapy 297

Intravesical Chemotherapy 297; Intravesical Immunotherapy 297; Indications of Intravesical Chemotherapy 297;

Contraindications 297; Prerequisite for Intravesical Therapy 297

Section 7: PeDiatric Urology

Development of Kidney 301; Kidney 302; Ureter and Renal Pelvis 304

44 Developmental Anomalies of the Upper Urinary Tract 306

Zahid Hossain Bhuiyan

Clinical Embryology of the Upper Urinary Tract 306; Renal Agenesis 306; Multicystic Dysplastic Kidney 306

Mozzam Hossain

Autosomal Recessive Polycystic Kidney Disease 309; Autosomal Dominant Polycystic Kidney Disease 309;

Multilocular Renal Cyst 310; Solitary Renal Cyst 310

Shafiqul Haque, Matiur Rahman

Etiology 311; Causes 311; Pathology 311; Work-up 312; Presentation 313; Staging of Wilms’ Tumor 313;

Management Principles 313; Treatment by Type and Stage of Wilms’ Tumor 314; Prognostic Factors 316

47 Congenital Ureteral Obstruction (Congenital Pelviureteric Junction and Vesicoureteral

Ureteropelvic Junction Obstruction 317; Bilateral Ureteropelvic Junction Obstruction 321; Complications 322;

Outcome and Prognosis 322; Future and Controversies 322; Follow-up 322

Imaging Techniques 324

Paddy Dewan

Cloacal Exstrophy (10%) 326; Classical Bladder Exstrophy (60%) 326; Epispadias (30%) 326;

Diagnosis of Bladder Exstrophy 328; Management of Bladder Exstrophy 328; Prognosis and Natural History 328

Ishteaq Ahmed Shameem

Patent Urachus 330; Urachal Cyst 330

Matiur Rahman

Major Characteristics 332; Associated Anomalies 332; Management 332; Work-up 333; Treatment 333

Paddy Dewan

Incidence 334; Pathophysiology 334; Causes 335; Consequences 335; Incidence 335; Grading System 335;

Diagnosis 336; Work-up 336; Management 337; Surgical Techniques 340; Follow-up 340

Paddy Dewan

Definition 342; Classification 342; Urodynamic Studies 342;

Management 343; Follow-up of Neurogenic Bladder Patients 344

Trang 25

Presentation of Rhabdomyosarcoma 348; Pathology 348; Pathologic Classification 348;

Clinical Groups of Rhabdomyosarcoma 349; Management 349

Shafiqul Haque

Diagnosis 350; Treatment of Testicular Torsion 352; Prognosis 352;

Perinatal Torsion 353; Epididymitis 353; Testicular Cancer 353

Paddy Dewan

Significance 355; Classification 355; Diagnosis 356; Investigations 356;

Treatment 357; Advantages of Early Orchidopexy 357; Prognosis 358

Diagnosis 361; Treatment of Varicocele 362

Paddy Dewan

Classification of Posterior Urethral Valves 364; Presentation of Posterior Urethral Valve or Membrane 364;

Work-up of Posterior Urethral Valves 365; Management of Posterior Urethral Valves 365;

Antenatal Treatment 365; Postnatal Treatment 366; Vesicostomy 366; Follow-up 366

MA Salam, Shahidul Islam Sugom

Diagnosis 368; Treatment 368; Methods of Circumcision 369

Ishteaq Ahmed Shameem

Presentation of Paraphimosis 373; Manual Reduction 373; Follow-up 374; Complications 374

Shafiqul Haque

Mechanisms of Sexual Differentiation 375; Disorders of Sexual Differentiation 376;

Work-up of Ambiguous Genitalia 376; Gender Assignment 378;

Timing of Genital Reconstruction 378; Management 378

History 382; Pathophysiology of Hypospadias 382; Classification System of Hypospadias 383;

Risk Factors for Hypospadias 383; Differential Diagnosis of Hypospadias 384;

Objectives of Repair of Hypospadias 384; Diagnosis 384; Treatment of Hypospadias 384;

Techniques for Posterior Hypospadias 387; Two-stage Hypospadias Repair 389;

Bladder/Buccal Mucosa Technique 390; Operative Technical Points 392; Complications of Hypospadias Repairs 393;

Hypospadias Patients with Multiple Failures 394; Long Term Follow-up 394

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Contents xxv

Section 8: neUroUrology

Gross Anatomy 399; Histology 399; Bladder Innervation 400; Sphincteric Mechanisms 400;

Bladder Neck in Male 401; Bladder Neck in Female 401;

The Physiology of Vesicourethral Segment 402; Uropharmacology 403

MA Salam, ATM Aman Ullah

Etiology of Flaccid Type of Neuropathic Bladder 406; Pathophysiology 406; Clinical Presentation 407;

Laboratory Study 407; Management of Flaccid Neuropathic Bladder 407;

Supplies Required for Self-catheterization Technique 408

MA Salam

Pathophysiology of Incontinence 411; Mechanism of Incontinence 412; Classification of Incontinence 412;

History 414; Causes of Neuropathic Bladder/Urethral Dysfunction 415; General Management 416

Jahangir Kabir

Causes 418; Symptoms 418; Classification 419; Work-up 419; Management 419;

Prognosis 420; Possible Complications 420

Functional Features of Bladder 421; Pathophysiology of Neuropathic Bladder 421;

Classification of Neuropathic Bladder 422; Outline of Diagnosis of Neuropathic Bladder 422;

Complications of Neuropathic Bladder 425;

Principle of Treatment of Neuropathic Bladder 427; Prognosis 427

Farakh Khan

Definition 428; Pathophysiology 428; Management 429

Jahangir Kabir

Pathophysiology 434; Clinical Presentation 435; Investigations 436; Management 437

MA Salam

Pathophysiology 440; History 440; Complete Spinal Cord Transection Syndromes 441;

Physical Examination of Spinal Cord Injury Patients 442; Causes of Spinal Injury 442;

Goals in the Management of Neuropathic Bladder in Spinal Injury 443;

Urodynamic Classification of Spinal Injury 443;

Prehospital Care and Transportation of Spinal Injury Patients 444;

Emergency Department Care 444; The Therapeutic Goal for Neurogenic Shock 445;

Complications 446; Prognosis 447; Lifelong Surveillance 447

MA Salam

Components of Urodynamics 449; Simple Urodynamics 450;

Complex Urodynamics 455; Practical Points of Urodynamic Study 457

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xxvi

Section 9: feMale Urology

Ajit Vaje

Definition 471; History 471; Mechanism of Stress Incontinence in Female 471;

Mechanism of Stress Incontinence in Male 472; Classification 472;

Work-up of Stress Urinary Incontinence 472; Treatment Options 476; Postoperative Care 483;

Risks and Complications 483; Selection of Therapy for an Individual Patient 483

Ajit Vaje

History of the Procedure 486; Incidence 486; Etiology 486; Pathophysiology 487; Risk Factors 487;

Presentation 487; Work-up 487; Treatment 488; Complications 490

Khoorsheed Jahan Maula

History of the Procedure 493; Incidence 493; Etiology 493; Classification 494;

Pathophysiology 494; Diagnosis 495; Management 497

Afiquor Rahman

New Concepts 501; Interstitial Cystitis Symptoms 501; Diagnosis 501; Management 502

Ajit Vaje, MA Salam

Frequency 504; Pathophysiology 504; Presentation 504; Work-up 504; Treatment 504;

Follow-up 505; Complications 505; Outcome and Prognosis 506; Future and Controversies 506

Section 10: Urinary tract obStrUction

History 509; Etiology 509; Pathophysiology of Obstructive Nephropathy 509; Presentation 510;

Work-up 511; Imaging Studies 512; Diagnostic Procedures 515; Treatment 515; Follow-up 517;

Complications 517; Outcome and Prognosis 517

MA Wahab, KM Monwarul Karim

Pathophysiology 519; Mortality/Morbidity 520; Presentation 520; Physical Examination 520;

Causes of Retroperitoneal Fibrosis 520; Differential Diagnosis 521;

Work-up 521; Histologic Findings 523; Treatment 523

Pranashish Saha

Classification 528; Incidence of Ureterocele 528; Etiology 528; Presentation 528; Laboratory Studies 529;

Imaging Studies 529; Principle of Treatment of the Ureterocele 531; Follow-up 532;

Complications of Surgical Intervention 532; Outcome and Prognosis 532

Prevalence 533; Pathophysiology 533; Presentation 533; Work-up 534;

Histologic Findings 535; Treatment 535; Follow-up 536; Complications 536

Paddy Dewan

Cause of Fetal Lower Urinary Tract Obstruction 537; Pathophysiology 537;

Diagnosis and Prognostic Criteria 537; Management Options and Outcomes 538;

Indications and Contraindications for Fetal Treatment 538; Follow-up 538

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Contents xxvii

Section 11: UrolithiaSiS

Ravindra Bhalchandra Sabnis

The Incidence of Urinary Tract Stone Disease 543; Pathophysiology of Urolithiasis 543;

Causes of Urolithiasis 543; Types of Stones 545; Mortality/Morbidity Related to Urolithiasis 546;

Clinical Review 546; Physical Examination 547; Differential Diagnosis 547;

Work-up 547; Treatment 549; Follow-up 551; Complications of Stone Disease 551;

Medical Treatment for Stone Disease 552; Prognosis 552

Md Fakhrul Islam

Clinical Findings 554; Work-up 554; Management of Acute Renal or Ureteric Colic 557;

Surgery for Recurrent Renal Colic 559

Technical Aspects 560; Evolution of Shockwave Lithotripters 561;

Indications of Extracorporeal Shockwave Lithotripsy 562; Work-up 563;

Factors Affecting the Outcome of Extracorporeal Shockwave Lithotripsy 563;

Preoperative and Intraoperative Stenting 564;

Techniques of Extracorporeal Shockwave Lithotripsy and Patient Care 564;

Follow-Up 564; Complications 564; Future and Controversies 565

Agrawal Madhu Sudan

Different Energy Sources Used in Intracorporeal Lithotripsy 566; Postoperative Care 567; Complications 568;

Outcome and Prognosis 568; Intracorporeal Lithotripsy and its Future 568

Mahesh R Desai

History 570; Relevant Anatomy 570; Indications 570; Contraindications 575;

Work-up 575; Treatment 576; Postoperative Care 577; Complications 577

Section 12: benign ProStatic DiSeaSe

KT Foo

Pathophysiology 583; Presentation of Benign Prostatic Hyperplasia 584;

International Prostate Symptom Score Index 584;

Work-up 586; Imaging Studies 586; Histological Findings 587;

Staging of Benign Prostatic Hyperplasia 588; Open Prostatectomy 590;

Transurethral Resection of the Prostate 590; Transurethral Incision of Prostate 591;

Transurethral Needle Ablation of the Prostate 593; Follow-up 595; Complications 595

Section 13: lower Urinary tract SyMPtoMS in Men anD woMen

KT Foo, MA Salam

Epidemiology 599; Presentation 599; International Prostate Symptom Score Index 599; Assessment 599;

Differential Diagnoses 601; Indications for Referral 601; Management of Lower Urinary Tract Symptoms 601;

Risk Factors for Urinary Incontinence 602; Presentation 602; Differential Diagnoses 603;

Investigations 603; Management 603; Complications 603; Prevention 603

Volume 2

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xxviii

Section 14: DiSeaSeS of the aDrenal glanD

Jagdeesh N Kulkarni

Anatomy of Adrenal Glands 607; Physiology of Adrenal Glands 607; Work-up of Adrenal Masses 608;

Adrenal Cysts 608; Aldosteronoma (Conn’s Syndrome) 609; Neuroblastoma 609;

Myelolipoma 609; Pheochromocytomas 609; Medical Therapy 610;

Postoperative Care 613; Follow-up 613; Complications 613; Prognosis of Adrenal Tumor 613

SAM Golam Kibria

Pathophysiology 615; Etiology 615; Pathology 616; Clinical Presentation 616; Laboratory Work-up 616;

Complications 617; Treatment 617; Prognosis 618

Pathophysiology 619; Mortality/Morbidity 619; History 620; Physical Examination 620; Work-up 621;

Additional Tests after the Diagnosis of Pheochromocytoma 622; Histologic Findings 622;

Staging 622; Treatment 623; Follow-up 623

Section 15: Practical Urology

Fazal Naser, Md Waliul Islam Maruf

Urethral Catheters 627

Moudud Hossain Alamgir, Shohrab Hossain

History of Catheterization 633; Indications 634; Contraindications 634; Materials for Urethral Catheterization 634;

Applied Anatomy 634; Catheters and Basic Designs 634; Urethral Catheterization in the Male Patient 635;

Catheter Maintenance 636; Problems during Urethral Catheterization 636; Contraindications 637;

Technique 638; Complications 639; Long-term Indwelling Catheters 639

AKM Khurshidul Alam

Indications for Catheterization in Female Patients 641;

Contraindications for Catheterization in Female Patients 641;

Equipment 641; Practical Anatomy 642; Procedure 642; Complications 642;

Difficult Catheterizations 642

Ahsan Kabir

Practical Urological Problem 644; Tips for Post-transurethral Resection Bleeding 644;

Management of Intractable Hematuria 644; Practical Urological Problem: Treatments for Intractable Hematuria 645;

Practical Urological Problem: Transurethral Resection Syndrome 645;

Practical Urological Problem: Deep Vein Thrombosis and Pulmonary Embolus 645; Pulmonary Embolus 646;

Practical Urological Problem: Elective Surgery on Anticoagulated Patients 646; Blocked Catheter 646;

Practical Urological Problem: Failure of Catheter Balloon to Deflate 647

99 Image Reproduction for Teaching, Documentation and Research 648

ABM Golam Rabbani

Videoendoscopic Surgery 648; Protocol for the Trainee and Students 648

100 Principles of Intravesical Chemotherapy and Immunotherapy 650

Promode Ranjan Singh

Contraindications 650; Dose and Duration of Therapy 651

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Contents xxix

Telescopic System 652; Urological Equipment for Lower Tract 653; Equipment for Upper Tract 657;

General Equipment in Urology Operation Theater 658; Sterilization and Care of Endoscopic Instruments 660;

Sterilization Methods for Urological Endoscopes 661

102 Irrigating Solutions for Urological Endoscopic Surgery 664

Nurul Hooda, Md Abdul Awal

Characteristics of Ideal Irrigating Solution for Transurethral Resection 664

Shailesh Raina, BK Dastur

History 666; Effects of Intermittent Catheterization 666;

Prerequisites of Clean Intermittent Self-catheterization 666;

Catheters and Catheter Care 667; Follow-up 668; Complications 668

Section 16: oPerative Urology

Mohsin Uddin

Ethical Issues 673; Indications 673; Routine Circumcision 673; Caution 674;

Circumcision for Patients with Phimosis 674

Prelude 677; Management 677; Complications 677

SM Mahbub Alam, AKM Zamanul Islam Bhuiyan

Anesthesia 679; Equipment 679; Positioning 680; Technique 680; Complications 680;

Open Suprapubic Cystostomy 681

MA Salam, Shadrul Alam

Indications of Cystoscopy 684; Sterilization of Cystoscope 684; Chromocystoscopy 687;

Complications 687; Narrow Band Imaging 688

SA Khan, Jahangir Kabir, M Hasan Akther

History of Ureteroscope 689; Indication of the Procedure 690; Work-up 690; Diagnostic Ureteroscopy 690;

Therapeutic Ureteroscopy 691; Postoperative Care 692; Complications of Ureteroscopy 692

Indications 703; Patient Preparation 703; Technique 703

Ahsan Kabir

Indications 705; Anesthesia 705; Equipment 705; Positioning 706; Technique 706;

Complications 707; Postvasectomy Success Rates 707

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xxx

113 Transurethral Resection of the Prostate and Bladder Neck Incision 709

Deen Sharma

History 709; Differential Diagnosis 709; Basic Applied Anatomy for Benign Prostatic Hyperplasia 711;

Equipment, Irrigation, Diathermy, Surgeon’s Chair 711; Technique of Transurethral Resection of the Prostate 711;

Postoperative Care 715; Histology of Transurethral Resection Chips 716;

Immediate Complications of Transurethral Resection of the Prostate 716;

Late Complications of Transurethral Resection of the Prostate 718;

Transurethral Resection in Carcinoma of the Prostate 720;

Transurethral Resection of the Prostate in Chronic Bacterial Prostatitis 720;

Transurethral Resection of the Prostate in Prostatic Abscess 720;

Transurethral Resection of the Prostate in Hypertrophy of the Bladder Neck 720

114 Bladder Tumor: Endoscopic Assessment and Treatment 725

Makarand V Khochikar

Bladder Tumor (Endoscopic Assessment) 725; Urethroscopy 726; Cystoscopy 726; Bimanual Examination 727;

Biopsy Technique 727; Cytology 729; Resection of Bladder Tumor 730; Special Points of Technique 731

Prem Nath Dogra

History of the Procedure 734; Etiology 734; Presentation 734; Indications 735; Relevant Anatomy 735;

Contraindications 735; Laboratory Studies 735; Imaging Studies 735; Other Tests 735; Treatment 735;

Open Ureterolithotomy 737; Follow-up 739; Complications of Ureterolithotomy 739

Indications 741; History of the Procedure 742; Work-up 742; Technique of Radical Nephrectomy 743;

Techniques of Open Radical Nephrectomy 744; Postoperative Complications 745; Outcome and Prognosis 746

Prem Nath Dogra

Etiology of Testicular Cancer 748; Pathology of Testicular Cancer 748; Differential Diagnoses 748;

Presentation of Testicular Cancer 748; Indications for Radical Orchiectomy 748;

Work-up 749; Surgery 749; Complications 750; Outcome and Prognosis 750

Cause 752; Pathophysiology 752; Diagnosis 753; Treatment 753

MA Salam

Indications for Radical Cystectomy 756; Indications for Urethrectomy 756; Work-up 756;

Biopsy for Bladder Cancer (Transurethral Resection of Bladder Tumor) 757;

Radical Cystoprostatectomy 758; Radical Cystectomy in Women 761;

Laparoscopic or Robot-assisted Laparoscopic Cystectomy 762; Postoperative Care 766; Complications 767;

Outcome and Prognosis 767; Alternative Therapy 767

History of Radical Retropubic Prostatectomy 770; Work-up 770; Preoperative Care 771;

Division of the Puboprostatic Ligaments and Control of the Dorsal Venous Complex 771; Complications 773;

Outcome and Prognosis 774; Follow-up 774; Future and Controversies 774

Rajeev Kumar

Pathophysiology 777; Work-up 777; Preoperative Preparation 778; Postoperative Details 780;

Outcome and Prognosis 781

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Contents xxxi

Muhammad Choudhury

Open Technique of Retroperitoneal Lymph Node Dissection 782; Follow-up 783

Mahesh R Desai

Various Energy Sources Used in Urinary Stone Management 785;

Indications and Technique of Management of the Urinary Stones 786; Postoperative Care 788;

Complications 788

124 Laparoscopic Cystoprostatectomy with Urinary Diversion 790

History 790; Preoperative Preparation 790;

Technique for Laparoscopic Cystoprostatectomy 790

MA Salam

History of Laparoscopy 794; Preoperative Patient Management 795;

Instrumentation for Developing the Extraperitoneal Space 796; Laparoscopic Hand Instruments 797;

Port Removal and its Closure 798

Shailesh Puntambekar

History of Laparoscopy 800; Physiology 801; Preoperative Preparation 802;

Laparoscopic Video Instrumentation and Cart 806; Postoperative Care 807; Complications 807;

Future of Laparoscopy 807

Techniques of Laparoscopic Adrenalectomy 809; Hand-assisted Laparoscopic Surgery 811

Definition 813; History 813; Approaches for Laparoscopic Nephrectomy 813;

Retroperitoneoscopic Laparoscopic Nephrectomy 815; Complications 815; Outcomes 816

Diagnosis 827; Indications 827; Complications 829

NP Gupta

Techniques of Radical Prostatectomy 833; Robotic Radical Prostatectomy 834;

Robotic Transperitoneal Approach 834;

Lymph Node Dissection and Development of the Extraperitoneal Space 835;

Advantages and Disadvantages of Robotics Versus Laparoscopy 836

Jahangir Kabir, NI Bhuiyan

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xxxii

Section 17: reconStrUctive Urology

Sanjay Kulkarni

History 843; Definition 843; Applied Anatomy of Male Urethra and Distal Sphincter Mechanism 843;

Female Urethra and Distal Sphincter Mechanism 845; Patch Urethroplasty of the Fossa Navicularis 849;

Urethroplasty 851; Onlay Graft Orientation 855; Oral Complications after Buccal Mucosal Harvesting 856;

Complications 858; Outcome and Prognosis 858;

Postoperative Erectile Dysfunction 859; Future of Urethral Stricture Management 860

MA Salam

Types of Cystoplasty 861; Indications of Cystoplasty 861; Contracted Bladder 861; Overactive Bladder 861;

Augmentation Cystoplasty 862; Substitution Cystoplasty 864; Postoperative Management 865;

Complications of Cystoplasty 866; Quality of Life 867

MA Salam

Definition 868; History of the Procedure 869; Indications 869; Classification of Urinary Diversion 869;

Work-up 870; Principles of Noncontinent Urinary Diversion 870;

Principles of Continent Urinary Diversion 873; Selection of Types of Urinary Diversion 875;

Preoperative Preparation and Care of Patients for Urinary Diversion/Orthotopic Bladder 877;

Postoperative Care of Urinary Diversion/Orthotopic Bladder 878;

Early Complications of Urinary Diversion/Orthotopic Bladder 879;

Late Complications of Urinary Diversion/Orthotopic Bladder 879;

Outcome and Prognosis of Urinary Diversion/Orthotopic Bladder 881;

Future of Urinary Diversion/Orthotopic Bladder 881

K Sasidharan

Vesicovaginal Fistula 883; Cystoscopy and Vaginoscopy 884; Principle of Operative Management 885;

Urethrovaginal Fistula 886; Ureterovaginal Fistula 887; Prostatic Fistula 888; Transrectal Repair 888;

Vesicoenteric Fistulas 889; Renal and Upper Urinary Tract Fistulas 890; Fistula of Urinary Diversion 890

Definition 898; Epidemiology 898; Causes 899; Pathophysiology 901; Diagnosis 903; History 903;

Management of Acute Kidney Injury 907; Renal Replacement Therapy 909

Harun-ur-Rashid

Pathophysiology 913; Work-up 914; Management of Chronic Kidney Disease and End-stage Renal Disease 915;

Management of the Coexisting Disease or Abnormalities in Chronic Kidney Disease 918;

Mortality/Morbidity 918; Prevention 918; Complications 918; Prognosis 918

Muhammad Rafiqul Alam

History 920; Drugs Used for Immunosuppression 920; Biologic Agents 921;

Primary Immunosuppressive Agents 922; Infection and Malignancy Issues 923

Pranjal R Modi

Technique 924; Hand-assisted Retroperitoneoscopic Donor Nephrectomy 926; Complications 926

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Contents xxxiii

MA Salam

History of Kidney Transplant 928; Concept of Histocompatibility 928; Identification of Suitable Donor 930;

Nephrectomy for Live Donor 931; Antegrade Pyelography 937; Surgical Complications 937;

Skin Cancers 939; Outcome of Renal Transplantation 939

Mahesh R Desai

History of Lap Donor Nephrectomy 941; Complications 943

Harun-ur-Rashid

Post-transplantation Morbidity and Mortality 944;

Important History in Transplantation Complications 945;

Renal Transplantation Complications 945; Chronic Allograft Injury 946;

Management Strategies for Common Presentations 947

Section 19: Uro-oncology

Jagdeesh N Kulkarni

Benign Tumors 951; Other Rare Benign Renal Tumors 953

Pathophysiology 956; Work-up of Renal Cell Carcinoma 957;

Work-up 958; Classification 959; Types of Renal Tumors 959;

Multikinase Inhibitors 967; Biologic Therapies 969;

Summary of Treatment of Renal Cell Carcinoma 970

MA Salam

Normal Urothelium 974; Risk Factors and Pathogenesis 974; Histopathology 975;

Treatment Options for Urothelial Cancer 977; Prognosis of Urethelial Cancer 978

MA Salam, Golam Mowla Chowdhury

Prelude 979; Epidemiology 979; Etiology 979; Pathophysiology 979; Diagnostic Procedures 983;

Staging 984; Treatment 985; Complications 987; Follow-up 987

MA Salam

External Beam Radiation Therapy 990; Pathology 990; Transitional Cell Carcinoma 991;

Work-up of Patient with Bladder Cancer 994; Imaging for Bladder Cancer 995;

Radical Cystoprostatectomy (Men) 1006; Anterior Pelvic Exenteration (Women) 1006;

Urinary Diversions 1008; Neobladder 1009; First-line Chemotherapy for ‘Fit’ Patients 1013;

Adenocarcinoma of the Bladder 1013

Christopher Cheng, MA Salam

History of Prostate Cancer 1019; Etiology of Prostate Cancer 1020;

Pathophysiology of Prostate Cancer 1022; Prostatic Intraepithelial Neoplasia 1023;

Work-up and Histologic Findings 1026; Management of Prostate Cancer 1028; Radical Prostatectomy 1029;

Follow-up of Prostate Cancer Patients 1035; Castrate-resistant Prostate Cancer 1036

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xxxiv

MA Salam, Sajid Hasan

Epidemiology 1041; WHO Classification of Testicular Tumors 1043;

Etiological Factors In Testicular Tumor 1044; Investigations 1045; CT/MRI/PET 1046;

Staging of Testicular Tumor 1047; Treatment 1048; Chemotherapy Regimens 1052;

Follow-up of Testicular Cancer 1054; Complications 1055; Prognosis 1055

MA Salam, Mohammad Shafiqur Rahman

Applied Anatomy of Penis 1059; Problem 1059;

Emotional and Physical Burden of Penile Cancer and its Treatment 1059;

Epidemiology 1059; Etiology 1060; Pathology 1060; Penile Malignant Tumor 1060;

Presentation 1061; Work-up 1061; Histological Diagnosis and Staging 1062;

Treatment 1063; Complications 1067; Prevention of Penile Cancer 1067

Section 20: reProDUctive Urology

Macroscopic Anatomy 1073; Histology 1073; The Vas Deferens and Seminal Vesicle 1074

MA Salam, Kazi Rafiqul Abedin

Pathophysiology 1076; Causes of Peyronie’s Disease 1077; Work-up 1077; Treatment 1077;

Prognosis and Complications 1079

Rajeev Kumar

Work-up 1083; Respiratory Disease 1085; Physical Examination for Male Infertility 1085;

Causes of Male Infertility 1086; Other Tests 1092; Treatment 1094

Rupin Shah

Cause of Infertility 1100; Diagnostic Tests 1100; Treatment 1102; Assisted Reproductive Techniques 1103

Rupin Shah

Prevalence 1105; Risk Factors for Erectile Dysfunction 1105;

Physiology of Erection 1107; Etiology of Erectile Dysfunction 1108; Work-up of Erectile Dysfunction 1108;

Causes of Erectile Dysfunction 1109; Sexual Function Score 1110;

Evaluation of Erectile Dysfunction 1110; Management of Erectile Dysfunction 1112

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Milestone of

Urology 1

• History of Urology

Trang 38

Urological diseases are as old as mankind This is

understood from the discovery of a vesical calculus in the

pelvis of a mummy from a prehistoric tomb in Egypt, which

was approximately 7000 years old Urological expertise

was also well-known in the prehistoric time where the

circumcision was clearly described (Figs 1.1 and 1.2)

Ritual circumcision on the 8th day of life was practiced

by the ancient Hebrews as evidence of God’s covenant

with Abraham, a story related in Genesis 17:10–14 A

more elegant artistic portrayal of this ancient rite may

be seen in Rembrandt’s etching of the circumcision of

Christ (Fig 1.3).

The elective operations first performed by man—

circumcision and cutting for bladder stone—the last was

free from religious or ritual conventions and may therefore

be pronounced, the most ancient operation undertaken

for the relief of a specific surgical condition

Fig 1.1: Prehistoric bladder calculus in the pelvis of a mummy

(Courtesy: Murphy Leonard JT History of Urology Charles C

Trang 39

Section 1 Milestone of Urology

4

PREHISTORIC UROLOGY IN DIFFERENT

PARTS OF WORLD

India

Indian medicine has a long history Its earliest concepts are

set out in the sacred writings called the Vedas, especially in

the metrical passages of the Atharvaveda, which may possibly

date as far back as the second millennium BC According

to a late writer, the system of medicine called Ayurveda

was received by a certain Dhanvantari from Brahma and

Dhanvantari was deified as the God of Medicine

Sushruta is the most celebrated physician and surgeon

in India Though he practiced during the fifth century

BC, many of his contributions to medicine and surgery

preceded similar discoveries in the western world

Sushruta devotes a complete volume of his experiences to

ophthalmologic diseases In the Uttar Tantrum, Sushruta

enumerates a sophisticated classification of eye diseases

complete with signs, symptoms, prognosis and medical/

surgical interventions In particular, Sushruta describes

what may have been the first extracapsular cataract

surgery using a sharply pointed instrument with a handle

fashioned into a trough (Fig 1.4) His ability to manage

many common eye conditions of the time with limited

diagnostic acids is a testament to his virtuosity

The “Sushruta Samhita” is a Sanskrit redaction text

on all the major concepts of ayurvedic medicine with

innovative chapters on surgery attributed to Sushruta (Fig

1.5) Amongst the eight divisions of medical knowledge,

surgery was considered the most important branch The

Sushruta Samhita contains 184 chapters and description

of 1120 illnesses, 700 medicinal plants, a detailed study

on anatomy, 64 preparations from mineral sources and

57 preparations based on animal sources Sushruta also described the various urethral bougie for dilatation of the stricture urethra

Sushruta recognized the four kinds of calculi caused by phlegm, bile, air or semen and he also described the stone prophylaxis in stone disease by prescribing strict vegetarian diet He described the treatment of extravasation of urine

by incision in the perineal region He practiced urethral installation of medicine for treating gonorrhea

Hippocrates (460–370 BC) is considered one of the most outstanding figures in the history of medicine He is referred to as the western father of medicine in recognition

of his lasting contributions to the field as the founder of the Hippocratic School of Medicine This intellectual school revolutionized medicine in ancient Greece, establishing

it as a discipline distinct from other fields and thereby establishing medicine as a profession

The Hippocratic physician paid careful attention to all aspects of his practice: he followed detailed specifications for, “lighting, personnel, instruments, positioning of the patient and techniques of bandaging and splinting” in the ancient operating room

Fig 1.4: Equipment used by Sushruta

(Courtesy: Sakti Das American Journal of Urology; 2001)

Fig 1.5: Sushruta

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Chapter 1 History of Urology 5

The Hippocratic school gave importance to the clinical

doctrines of observation and documentation These

doctrines dictate that physicians record their findings

and their medicinal methods in a very clear and objective

manner so that these records may be passed down and

employed by other physicians Hippocrates made careful,

regular note of many symptoms including complexion,

pulse, fever, pains, movement and excretions He is said

to have measured a patient’s pulse when taking a case

history to know if the patient lied Hippocrates extended

clinical observations into family history and environment

“To him medicine owes the art of clinical inspection and

observation.’’ For this reason, he may more properly be

termed as the “Father of Clinical Medicine.”

He recognized and described stone disease but also

stated, “I will not cut persons laboring under the stone but

will leave this to be done by practitioners of this work.”

Possibly, this was the earliest recommendation for super

specialization in medicine Renal and bladder injuries,

and disorders were described by Hippocrates (Fig 1.6);

and reference made to the drainage of renal abscesses He

regarded wounds of the bladder as carrying a very grave

prognosis and it may have been this view that held surgeons

back from the transabdominal approach of the bladder

The Hippocratic Oath

The Hippocratic Oath is an oath traditionally taken by

physicians, in which certain ethical guidelines are laid

out It is thought to be written by Hippocrates and some

scholars Several parts of the oath have been removed or

reworded over the years in various countries, schools and

societies but the oath still remains one of the few elements

of medicine that has remained unchanged

Middle East

The “Canon of Medicine” is a 14-volume medical encyclopedia compiled by Ibn Sīnā (Avicenna) and completed in 1025 (Fig 1.7) The book was based on the

writings of the Roman physician Galen and Hippocrates as told by Galen It presents a clear and organized summary

of all the medical knowledge of the time Originally written

in the Arabic language, the book was later translated into

a number of other languages including Persian, Latin, Chinese, Hebrew, German, French and English The Canon

is considered one of the most famous books in the history of medicine The Canon of Medicine was used as a textbook in the universities of Montpellier and Louvain as late as 1650 For 1000 years, he has retained his original renown as one of the greatest thinkers and medical scholars in history His most important medical works are the Qanun (Canon) and a treatise on cardiac drugs The “Qanun” is an immense encyclopedia of medicine It contains some of the most illuminating thoughts pertaining to distinction of mediastinitis from pleurisy, contagious nature of phthisis, distribution of diseases by water and soil, careful description of skin troubles, sexual diseases and perversions and nervous ailments

Abul-Qasim, etc described flexible catheter and uroscopy Islamic philosophers and the physician Ibn al-Nafis (1210–1288 AD) in Damascus succeeded in finding that the lung circulation was a closed system Without Islamic science, the European renaissance would not have begun and come to maturity

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