Knowledge about cancer genetics is rapidly expanding, and has implications for all aspects of cancer research and treatment, including molecular causation, diagnosis, prevention, screening, and treatment.

Additionally, while cancer genetics has traditionally focused on mutational events that have their primary effect within the cancer cell, recently the focus has widened, with evidence of the importance of epigenetic events and of cellular interactions in cancer development. The role of common genetic variation in determining the range of individual susceptibility within the population is increasingly recognized, and is now being widely addressed using information from the Human Genome Project. These new research directions will highlight determinants of cancer that lie outside the cancer cell, suggest new targets for intervention, and inform the design of strategies for prevention in groups at increased risk.

Today, the NCI is putting more and more money into research into the genetics of cancer. The very first of the NCI s stated research priorities is a project called The Cancer Genome Atlas. The Cancer Genome Atlas (TCGA) is a comprehensive and coordinated effort to accelerate the understanding of the molecular basis of cancer through the application of genome analysis technologies, including large-scale genome sequencing. The NCI and the NHGRI (National Human Genome Research Institute, where the series editor is employed) have each committed $50 million over three years to the TCGA Pilot Project.

This book proposes cover the latest findings in the genetics of male reproductive cancers; specifically cancers of the prostate and testes. The volume will cover the epidemiology of these cancers; model systems, pathology, molecular genetics, and inherited susceptibility."

The effect of calcium antagonists on heart muscle and blood circulation is the reason that they have found widespread clinical application for a number of years. Less well known, in contrast, is the effect this group of substances has on the kidneys, both on kidney cells and the blood flow through the kidneys. This effect was the subject of a workshop we organized in Tiibingen in June 1986. Different groups studied the effects of these substances, especially in animals, on the processing of calcium by the kidney cells and on blood flow. A possible explanation is that the calcium antagonists block the influx of calcium through special cell canals, especially the cells of the distal tubule. It is necessary to test whether there is a blockade or only a reduction in the passage of calcium. Our understanding of the effect of calcium antagonists is in large part based on the results of morphologic, physiologic, and pharmacologic studies of calcium in the kidneys. The particular processes involved in nephrocalcinosis are special objects of study with regard to calcium antagonists. This book presents the results of experimental studies of the effect of calcium antagonists on nephrocalcinosis and acute renal failure after ischemia. In this context, the clinician is particularly interested in the use of calcium antagonists to protect against the kidney in urolithiasis, in acute renal failure and during kidney transplantation. The book is thus of interest to urologists and nephrologists as well as pharmacologists. biochemists, physiologists, and others in research.

Education, patient care, and research combine into the expression of what is known as a university center: a place of learning, a place of development, a place of patient care and cure, a place of compassion, a place of progress. Many centers reflect to the highest degree all of these qualities. Those of us within this volume wish to give testimony to the urological center developed, designed, and cared for by Dr. William Wallace Scott. This man, in our opinion, reflects all of the preceding features to the highest degree. We in Urology have benefited greatly by his leadership and counsel. Herein will be found articles on patient care, research, education, and historical vignettes. These can hardly be a measure of the man but serve to underline modern progress in Urology and clinical research. LOWELL R. KING, M. D. GERALD P. MURPHY, M. D. , D. Sc. v Patrons DR. J. ARCADI DR. J. M. HOLLAND DR. W. BRANNAN DR. W. J. HOPKINS DR. H. BRENDLER DR. W. J. KEARNS DR. H. J. BRADLEY DR. L. R. KING DR. R. W. BRIDGE DR. B. KosTO DR. W. W. S. BUTLER DR. A. MITTELMAN DR. R. L. CALHOUN DR. G . P. MURPHY DR. W. A. CAMPBELL DR. I. J. NUDELMAN DR. D. M. DAVIS DR. L. PERSKY DR. J. N. DE KLERK DR. R. B. ROTH DR. R. M. ENGEL DR. P. L. SCARDINO DR. R. P. FINNEY DR. J. D. SCHMIDT DR. R. P. GIBBONS DR. J. H.

It must be considered that there is nothing more difficult to carry out, nor more doubtful of success, nor more dangerous to handle, than to initiate a new order of things. Machiavelli: The Prince (1513) These are the Proceedings of a Conference on Temperature and Environmental Factors and the Testis which took place at New York University School of Medicine, December 8th and 9th, 1989. There is good reason to believe that this was the first of its kind to address, exclusively, the implications of temperature for this highly thermosensitive organ and its precious genetic cargo. The organizers of the Conference hoped to stimulate interest in this area which, paradoxically, has a considerable literature but which has received scant attention and sometimes outright opposition from clinicians expert in male infertility. There have been studies of the relationship of temperature to reproduction starting in the mid-18th Century with observations of the relationship of water temperature to spawning of fish. There is also a vast literature on the deleterious effects of externally applied heat upon spermatogenesis but little study of the possibility that intrinsic heat may be an important etiologic factor in subfertile semen. Today, fertility research has largely ignored this in favor of research in areas which have not produced successes, in terms of live births, comparable to what can be obtained by varicocelectomy (when appropriate) or scrotal hypothermia: viz. 1. Concentration upon the endocrine aspects of testicular function and its relation to spermatogenesis.

My introduction to androgens was neither auspicious nor impressive. I was sitting my viva voce examination for a degree in physiology and had haltingly intimated to my examiner (name decorously withheld) that I intended to pursue a career in re search. "On what topic?" was the reply. I had been deeply impressed by the work of C. Huggins and C. V. Hodges (Cancer Res. 1, 293, 1941) on the dramatic arrest of canine prostatic hyperplasia by the administration of stilboestrol. With some en thusiasm, I responded, "On steroid hormones, because I am struck by the profound effects that may be achieved by relatively small numbers of molecules. " The examiner sank into deep contemplation before replying, "Young man, have you considered go ing into teaching?" Suitably chastened, I finally began my research career investigating the effects of steroids on the nucleic acid metabolism of experimental tumours and on the process cells. Reaching an impasse in this work, I mentioned one of senescence in animal day to Dr. G. F. Marrian that, somewhat surprisingly, we had no understanding of the fundamental mechanism of action of steroid hormones, especially the androgens. me to tackle this problem, particularly since exciting new insights He encouraged were then being made into the interaction of radioactively labelled oestradiol-l?,8 with such tissues as rat uterus."

Benign prostatic hyperplasia (BPH) is an age-related, nonmalignant condition that may lead to bothersome lower urinary tract symptoms. The standard treatment of BPH has been ordinary loop transurethral prostatectomy, but new therapies have been developed as a combined result of research, technological advances, and the cumulative experience of urological surgeons. Among the most promising therapeutic alternatives to ordinary loop resection are those that deliver topical or interstitial heat to prostatic tissue. Transurethral microwave thermotherapy, visual laser ablation with the Nd: YAG laser, high-intensity focused ultrasound, and transurethral electrovaporization are some of the techniques described in this book. These innovative procedures, employed by skilled urologists using state-of-the-art instruments, hold forth the promise of improved quality of life for BPH patients and represent significant advances in the field of urology

The Fourth International Congress of Peritoneal Dialysis was held in Venice, Italy, June 29 to July 2, 1987. By this time peritoneal dialysis had emerged as a treatment for a substantial fraction of patients with end-stage renal disease and countless numbers of patients with acute renal failure. This treatment is now practiced worldwide and is the life-sustaining treatment for about 40,000 patients with chronic renal failure, representing 15 to 20% of dialysis therapy in about 1000 centers. It is not surprising, therefore, that the number of health professionals engaged in the investigation and the application of the treatment has also grown exponen tially. The First International Symposium on Peritoneal Dialysis, organized by Dr. A. Treviiio-Be cerra in Chapala, Mexico, in 1978, brought together a group of pioneers when continuous ambulatory peritoneal dialysis was in its infancy. In 1981, Dr. G. M. Gahl chaired the Second Symposium, in West Berlin, when the technique and professional interest were growing con siderably. By 1984, when Dr. 1. F. Winchester and I organized the Third Symposium, the pre sented papers exceeded 100 and there were about 1000 attendees. At that time, it was deemed appropriate to form a more organized group and the International Society for Peritoneal Dialy sis was founded. One of the first actions of the Society was to choose from among several applicants Dr."

Starting in 1986, the European School of Oncology has expanded its activities in postgraduate teaching, which consisted mainly of traditional disease-orientated courses, by promoting new educational initiatives. One of these is the cloister seminars, short meetings intended for highly qualified oncologists and dealing with specific, controversial aspects of clinical practice and research. Another is the institution of permanent study groups, also called task forces, where a limited number of leading experts are invited to meet once a year with the aim of defining the state of the art and possibly reaching a consensus on developments and treatment in specific fields of oncology. This series of ESO Monographs was designed with the specific purpose of disseminating the results of the most interesting of the seminars and study groups, and providing concise and updated reviews of the subjects discussed. It wa& decided to keep the layout very simple in order to keep costs to a minimum and make the monographs available in the shortest possible time, thus overcoming a common problem in medical literature: that of the material being outdated even before publication.

In this book we have expert urologists and gynaecologists on the two sides of the Atlantic working together with a common interest, the inadequate female urethra. What makes this volume so valuable is that it is not restricted to one speciality or one cult, but bravely (and systematically) presents established principles and practice. Not only is the current knowledge of the anatomy and function of the continence mech anisms defined by experts carefully selected by the two authorities in the field, but this infor mation is directly applied to clinical problems for the reader to use in the care of patients. Because the basics are presented first, and followed by the methods of diagnosis, the sec tions describing each form of treatment, whether medical or surgical, are set on rational bases. These are not cookbook directions. This background is especially valuable because the incontinent female usually has a complicated disorder, each case being different, so that the responsible gynaecologists or urologists must apply as much understanding as technique if their efforts are to achieve dryness. The clear descriptions and illustrations in this book, then, act as guides as much as directives. This second edition builds on the success of the first. All of us trying to help these unfortu nate women will do more for them from having this new edition at hand."

Aeeuraey in preoperative diagnosis has always been the basis of sueeess in urology. In the past deeade, major advanees have been made in diagnostie imaging of the kidney and genitourinary traet. Of the new reliable teehniques available, eeho- graphy, radioisotope studies and eomputerized tomographie seanning are of the greatest importanee in the investigation of renal and urinary traet diseases. These new methods of investigation have led to a radical change in the attitude and prae- tieal approach when evaluating a patient presenting with a urologie disorder. The teeh- niques each yield information of a different type and in eonjunetion with classie ra- diology must be used safely and with a logical sequenee in the investigation of a diag- nostie problem. They have greatly inereased the available evidenee on whieh diag- nosis is based and their use should diminish the number of false diagnoses and ul- timately improve treatment. The applieations ofthese reeently developed diagnostie methods in urology are reviewed in this book, based on the main eontributions given by a wide range of experts in their field during the last Congress of the European Assoeiation ofUrology, held in Athens in 1980. Intravenous urography, the first and major step in urologie diagnosis, developed more than half a eentury ago, ean still be improved, as shown by the routine use of early nephrotomography with rapid injeetion.

Pathobiology of Human Germ Cell Neoplasia is a state-of-the-art compendium on a very recent branch of tumor biology. It offers an awareness and understanding of germ cell tumors: from the earliest stages to their va- rious differentiations. Original data for this volume was supplied by experts in the fields of pathology, developmental biology, genetics, molecular biology and other related fields. This compilation of knowledge provides information necessary to persons working in clinical and preclinical areas.

Cytologic diagnosis of cancer has its roots in clinical micro scopy as it was shaped during the first half of the 19th century. In reviewing some of the early writing on this subject, one is amazed at the accuracy of the descriptions and soundness of the observations. Cytology of the urine is no exception: in 1864 Sanders described fragments of cancerous tissue in the urine of a patient with bladder cancer (Edinburgh Med. J. 111, 273). This observation was confirmed by Dickinson in 1869 (Tr. Path. Soc. London, 20, 233). It is a source of special pride to me that in 1892 a New York pathologist, Frank Ferguson, advocated the examination of the urinary sediment as a best means of diagnosing bladder cancer, short of cystoscopy. Papanico laou freely acknowledged these contributions while estab lishing sound scientific bases for continuation and spread of this work. Papanicolaou's work in the area of the urinary tract has not fallen on dead ears. He documented to several urologists who were within his sphere of personal influence, mainly Dr. Victor Marshall, Professor of Urology at Cor nell University Medical School, that urinary tract cytology was a reliable tool in the diagnosis of urothelial carcinoma. Some of us who have attempted to spread the master's word had their share of success within institutions with which we were associated.

Material for this book was gathered in the early 1980's in Manchester, where a higher incidence than usual of complications in the gastro-intestinal and urinary tract was observed. Part I describes the principles and methods of radiotherapy for pelvic tumours, pathological features and radiological analysis of bowel and urinary tract changes. Parts II and III are devoted to clinical assessment and management, where the need for a multi-diciplinary approach is emphasized.

Urolithiasis is not only one of the most frequently encountered diseases at uro logical clinics; it is also the disorder whose treatment has shown the most rapid progress in the past decade. In that period, medicine has experienced a real revolution, characterized by minimally invasive treatments, improvement of the quality of life, and cost-effectiveness in treatment outcomes. In urology, the revolution started with the development of endoscopic retrograde treatment of urolithiasis in the upper urinary tract, which led to development of the percuta neous antegrade maneuver in the latter half of the 1970s. The most remarkable event occurred in 1982, when clinical use of extracorporeal shock wave lithotripsy was introduced by the Munich group, represented by Dr. Christian Chaussy, at the 18th Congress of the International Society of Urology in San Francisco. With the advent of these new strategies, open surgery for urolithiasis has all but dis appeared. Today, with the availability of new technology and equipment, guide lines for the treatment of urolithiasis have changed in all developed countries. It is quite timely that the Meeting of International Consultation on Urolithiasis will be held in Paris in June 2001 to establish international guidelines for urolithiasis. Looking through this textbook for urolithiasis, I was greatly impressed to learn that we have already drawn up some guidelines. The book includes all the updated advances of urolithiasis presented by the most prominent and experi enced urologists from all around the world.

For many years, patients who complained of prostatism had only a few treatment choices. The patient was either a candidate for an elective prostatectomy, or the operation was deferred until the patient became more symptomatic. The present text summarizes the multiple options which have become available to the practicing urologist. Minimally invasive techniques such as transurethral incision of the prostate, balloon dilatation, hyperthermia, laser therapy, and prostatic stents are described. Medical treatment with alpha-blockers, 5 alpha-reductase inhibitors, and flutamide are addressed by authors who have had extensive clinical experience with the use of these agents.

The past 15 years have witnessed a marked increase in attempts to identify safe and effective treatment alternatives to prostatectomy. This book is a review of the current therapeutic efforts in the management of patients with benign prostatic hyperplasia. It is presented by a group of highly regarded basic and clinical scientists with a major interest in prostatic diseases.
The information provided in this book is aimed at a wide audience including private practice and academic urologists, research fellows and doctors in postgraduate training, and basic scientists interested in prostatic pathology.

In the last decade, physicians have witnessed a publication will serve as a stimulus to surgeons growing awareness of and concern with diseases of concerned with male reproductive disorders to in the male reproductive tract. Stimulated by this tensify their personal research attempts to develop interest, a refinement and re-evaluation of existing better therapy for diseases referable to the male reproductive system. It is finally hoped that this surgical techniques for treatment of male repro ductive disorders has been concurrently appreci publication will stimulate critical analysis of what ated. Rapid progress in this area has resulted we feel are currently accepted surgical modes of primarily from a cooperative effort from those therapy and to better promote a general inter specialists in the areas of microsurgery, medical change of clinical information referable to these and surgical oncology, endocrinology and neuro disorders. physiology, pathology, immunology, genetics and Those who have provided the text and illustra biochemistry. tions for this volume have contributed a significant As the surgical treatment of diseases and ab amount of work, and we hope that they feel their normalities of the male reproductive system has material has been well used. The editors also wish to expanded, so have the articles describing these often thank Mr."

One out of every two men over eigthy suffers from carcinoma of the prostate.It is discovered incidentally in many patients with an alleged benign prostatic hyperplasia. In treating patients, the authors make clear that primary radical prostatectomy is preferred over transurethral resection due to the lower complication rate.

Volume XV "Urology in Childhood" was written in 1956/57 and was the first in the series of the Encyclopedia of Urology to appear. This present volume has been constructed as a supplement and the original intention was to deal only with those subjects in which there have been significant advances during the intervening sixteen years. As the work has proceeded, however, it has become evident that there is no aspect of paediatric urology which has not been developed, and no topic which has not been illuminated by many contributions to the literature. Indeed, there has been such a copious flow of publications devoted to children's urinary tract disease that a full review is no longer possible within the compass of a volume of this size: the decision as to what should be left out has therefore been a matter of the greatest difficulty. The choice has been inevit ably arbitrary and many omissions are regretted. The attempt has been made, however, to report the most notable developments of the subject, and perhaps the greatest change in the practice of paediatric urology has been the full integra tion with paediatric nephrology. The team approach to infant disease in particular has led to greatly improved results. I have been fortunate to have Dr. T. M."

How to treat advanced prostatic cancer remains controversial, despite intense basic and clinical research investigating the pathogenesis and natural history of this unique cancer highly prevalent in elderly males. Nine experts were asked to meet and discuss the facts. This resulting monograph gives an overview of the available knowledge on all aspects of the subject. The objective evaluation and consensus opinion of the authors presented here set this book apart from other publications with conflicting viewpoints. For readers eager to obtain a comprehensive and balanced view of the thousands of clinical contributions and clear advice on the choices, this book is a must.

Disintegration of kidney and gall stones by intense laser radiation is becoming increasingly important as a complementary technique to extracorporeal shockwave treatment. This book gives for the first time a complete overview of laser lithotripsy combining a critical comparison of the methods and a thorough evaluation of instrumental developments and clinical applications. Readers from the medical as well as from the engineering side will find it a stimulating source of information on all aspects of laser-stone interaction.

Stone in the urinary tract has fascinated the medical profession from the earliest times and has played an important part in the development of surgery. The earliest major planned operations were for the removal of vesical calculus; renal and ureteric calculi provided the first stimulus for the radiological investigation of the viscera, and the biochemical investigation of the causes of calculus formation has been the training ground for surgeons interested in metabolic disorders. It is therefore no surprise that stone has been the subject of a number of monographs by eminent urologists, but the rapid development of knowledge has made it possible for each one of these authors to produce something new. There is still a technical challenge to the surgeon in the removal of renal calculi, and on this topic we are always glad to have the advice of a master craftsman; but inevitably much of the interest centres on the elucidation of the causes of stone formation and its prevention. Professor Pyrah has had a long and wide experience of the surgery of calculous disease and gives us in this volume something of the wisdom that he has gained thereby, but he has also been a pioneer in the setting up of a research department largely concerned with the investigation of this complex group of disorders, so that he is able to present in terms readily intelligible to the general medical reader the results of extensive biochemical investigation in this area.

The book provides a comprehensive uptodate review of the present state of knowledge of urinary enzymes. Since it deals with all the essential questions currently being discussed in connection with urinary enzymes, it will be of interest to biochemists, clinical chemists, renal physiologists, nephrologists and clinicians working on renal problems.The chapters are grouped into 5 parts, the first offeringan update of the biochemical and morphological fundamentals of the excretionof urinary enzymes, including a description of the distribution of diagnostically relevant enzymes along the nephron, the mechanisms of enzyme release, and the physiological factors influencing the excretion rate. The chapters in the second part deal with the methodological fundamentals ofthe activity determination of urinary enzymes (preanalytical treatment, quality assurance, methodical details for the most important enzymes, reviewon reference intervals). The four chapters in the third part review aspects of urinary enzyme excretion in clinical medicine (renal, renal associated, and urological disorders, kidney transplantation, nephrotoxicity, extrarenal diseases) and includes a special chapter on the general background for interpreting data on urinary enzyme excretion. The fourth part, consisting of 3 chapters, covers urinary enzymes in animal experiments (animal models, influence of different substances on urinary enzyme excretion, reference values in various animals). The book concludes with a review of the posibilities for using renal enzymes as the basis for alternative methods of screening toxic substances.

The purpose of this book is to provide some basic information regarding the fundamentals of magnetic resonance (MR) for all those who are less familiar with the technique and interested in MR spectroscopy and its possible applications in research and clinical practice. It will stimulate the reader to look more closely at the various topics covered by the contributors to this volume: tumor cell metabolism, kidney function, organ viability. Finally, several applications of high-field spectroscopy and imaging are illustrated. The book focusses on proven and possible clinical applications of MR in nephrourology: renal cell carcinoma, metabolic investigation of the kidney and pretransplant assessment of organ viability. The examples are thoroughly discussed and abundantly illustrated. The reader will benefit from this book by receiving a review of research and clinical aspects of MR simultaneously.

The first symposium of the working group on experimental urology of the German Society of Urology was held in Cologne in 1972. It was meant to be a platform to present and, in particular, to discuss experimental studies developing new diagnostic and therapeutic approaches, and to promote in novation in urology in Germany. This plan was well received, and during the last 16 years both the number of participants from other European and overseas countries and the number and quality of presentations have been continuously increasing. At the most recent meeting, held in Aachen in 1988, new data were presented on renal cell cancer, andrology, prostatic cancer and adenoma, bladder cancer, urinary diversion, urodynamics, renal pathophysiology, transplantation and the pathogenesis and treatment of urolithiasis. The present book contains 44 of the 109 papers given at the Aachen meeting, covering both basic and clinical research. It will be of eminent interest to all scientifically minded urologists, oncologists, neurophysiolo gists, endocrinologists, and pathologists because it is a synopsis of all the major scientific research currently being conducted in urology in Europe. There are no other books available which offer as comprehensive a cover age of recent experimental issues in urology. The aim of the series Inves tigative Urology is to demonstrate the continuous development of research in urology and to encourage all colleagues interested in experimental urol ogy to continue their important activities and create new international co operation.