Impending famine and a terrifying rate of consumption of natural resources are vital issues which have focussed public interest in the ecologic, social and political problems of ever increasing overpopulation in many countries of the world. As well as the vast material and intellectual expenditure lavished on family planning and birth control, the past decade has seen an immense research effort in the elaboration of improved methods of fertility control, both for men and for women. During the same period, however, research into the causes of male fertility disorders has proceeded with equal intensity, and a number of promising therapeutic approaches have become the subject of clinical trials. The wish of an individual or of a couple to have offspring is an absolute which requires no further justification, and there can be few challenges to a physician as essential as the spouses' predicament in a childless marriage. Only with a special knowledge of the function, pathology and pathophysiology of the reproductive system is he properly equipped to meet that challenge.

Carcinoma of the prostate increasingly dominates the attention of urologists for both scientific and clinical reasons. The search for an explanation and the prediction of the variable behaviour of the malignant prostatic cell continues unabated. The search for more precise tumour staging and more effective treatment is equally vigorous. Editors Andrew Bruce and John Trachtenberg have assembled acknowledged leaders in prostate cancer to present those areas of direct interest to the clinician. There are a number of other topics that might have been considered but most of these, such as experimental tumour models or biochemical factors affecting cell growth, still lack immediate application for the clinician. Carcinoma of the prostate continues to have its highest incidence in the western world, and the difference in comparison with the incidence in the Far East appears to be real and not masked by diagnostic or other factors. A number of other epidemiological aspects need careful analysis: Is the incidence increasing? Is the survival improving? Is the prognosis worse in the younger patient? Epidemiological data are easily misused and misinterpreted so that a precise analysis of the known facts makes an important opening chapter to this book.

Once urology was established as a medical specialty, the initial anatomic-morpho logical point of view was soon supplemented by functional considerations and diagnostic procedures, thanks to the introduction of the cystoscope (NrTzE, 1877) and retrograde pyelography (VOELCKER, ]OSEPH and VON LrCHTENBERG, 1903). Intravenous urography (VOLKMANN, 1924; VON LrCHTENBERG, PFLAUMER and SWICK, 1929) lent roentgen examinations a more functional aspect. The word "urodynamics" refers to the functional approach to the urinary trac- from the renal pelvis and calyces, the ureter and bladder down to the bladder neck and urethra. The embryologically denned topographie regions of the urogenital tract are peripheral relays, while the actual site of action of both normal and patho logical urodynamics is to be found in the various hollow muscular organs. Despite extensive basic research and much knowledge acquired in this neld, the active transport system between site of production and storage, i. e. the renal pelvis and ureter, is still regarded in clinical practice mainly from the anatomic-morphological viewpoint. It is not easy to obtain adequate information for the clinical assessment of functional disturbances of the ureter. For instance, retrograde exploration methods may often be complicated by infection. Clinically applicable methods for functional assessment of the upper urinary tract are (RUTISHAUSER): direct observation of the ureteral orinces, intravenous and retro grade visualization by roentgen contrast medium, sequential pyelography, roentgen kymography, and cinematography. Such methods allow good functional exploration by an experienced investigator but they yield hardly any objectively reproducible records."

Die Traumatologie des Urogenitaltraktes gewinnt im Blickpunkt der fort- schreitenden Industrialisierung und Technisierung sowie der zunehmenden Ver- kehrsdichte eine praktische Bedeutung, die sich in samtlichen Gebieten der diagnostischen und klinischen Medizin zunehmend bemerkbar macht. Die Konzeption des Bandes beriicksichtigt die aktuelle Entwicklung neuer medizinischer Disziplinen, z.B. die interdisziplinare Stellung der Urologie zwi- schen Unfallchirurgie und groBer Chirurgie, die Wandlung der R6ntgendiagno- stik von den konventionellen Methoden zur differenzierten Nukleardiagnostik und modernen Computerdiagnostik, das Herausarbeiten abgestimmter diagno- stischer Stufenplane sowie daraus folgender primarer oder sekundarer Versor- gungsplane des Polytraumatisierten. Damit wurde die zwar organisch faBbare und anatomisch nachvollziehbare Isolierung von Niere, Harnleiter und Blase aufgegeben und der gesamte Urogeni- taltrakt einschlieBlich des auBeren Genitales in ein funktionell zusammenMngen- des Netz eingebettet. Das bedeutet die Koppelung diagnostischer Prioritaten mit teilweise spezifischen Therapiekonsequenzen. Die einzelnen Kapitel scheinen auf den ersten Blick nicht organisch aneinan- der gekoppelt zu sein. Der Polytraumatisierte bildet eine komplexe und doch differenzierte Betrachtung und ist deshalb an den SchluB gestellt. Das isolierte Nierentrauma beim Kind und beim Erwachsenen verlangt eine verfeinerte dia- gnostische Ausleuchtung; die friiher invasiven Methoden wurden durch nicht invasive, aber sichere diagnostische M6glichkeiten ersetzt. Die Traumatologie von Harnblase sowie vorderer und hinterer Harnr6hre mit oder ohne Beckenfraktur ist breit und umfassend abgehandelt. Die Vor- machtstellung dieses Kapitels gegeniiber den anderen wird durch die detaillierte Ausarbeitung charakterisiert.

A Clinical Guide to Urologic Emergencies A Clinical Guide to Urologic Emergencies An ageing population and a predicted shortfall in the number of urologists means that, increasingly, the management of complex urological problems will fall to hospital emergency departments and the surgeries of primary care physicians. With many doctors and medical students now having less exposure to urology, there is a real and urgent need for accessible and practical guidance in managing urologic emergencies. A Clinical Guide to Urologic Emergencies offers practical guidance to the best practices in diagnosis, treatment and management of patients with urgent urological conditions. Designed to be an extremely useful tool to consult in the clinical setting, it will be a vital source of information and guidance for all clinicians, irrespective of their level of urologic knowledge. Edited by an outstanding international editor team, this book is particularly aimed at physicians, advanced practice providers, and urology and emergency medicine trainees managing patients in diverse healthcare settings across the globe. A Clinical Guide to Urologic Emergencies is accompanied by a website featuring video content at www.wiley.com/go/wessells/urologic

For more than a century, the condition now known as Idiopathic Hydronephrosis has been recognised as a clinical entity, and following the original description by Rayer in 1841 a variety of procedures were devised in attempts to correct the condition surgically. Most of these early methods were introduced in the last decade of the nineteenth century by several illustrious clinicians, including Trendelenburg, KOster, Fenger and Sutton. For many years diagnosis was based purely upon the patients presenting signs and symptoms and not until the early part of this century was technology available to assist in the pre-operative diagnosis of the condition. Early methods depended upon radiological techniques, and the introduction of the retrograde pyelogram by Voelcker and Lichtenberg in 1906 represented a significant advance in diagnostic methodology. Other methods also dependent upon radiographic techniques were subsequently introduced, including urography in the late 1930s by Swick, and more recently, the method of cineradio graphy, as pioneered with considerable success by Peter Narath in the decade following World War II. During the past 50 years a variety of surgical procedures have been introduced for the treatment of idiopathic hydronephrosis. That so many different methods have been devised suggests that no one specific technique is capable of achieving a complete cure in all cases."

Sexology as a discipline has had to fight for full-fledged recognition in the scientific community. Yet special knowledge of normal and disturbed sexual behavior is expected of medical professionals, psychologists and educators alike. Based on the papers given at the 8th World Congress for Sexology in 1987, this volume gives an up-to-date discussion of the most interesting and controversial topics, such as AIDS, in the field. Contributions have been grouped under the main headings: Family Planning, Sterility and Sexuality, Erectile Dysfunction, Sexuality in the Elderly and in Marriage, Transsexualism, Sexual Therapy, and Sexuality and Illness, and include items of historical interest as well as transcultural comparisons.

For more than 60 years, the Californian Family Hinman has exercised a very considerable influence on the development and practice of the highest grade of urology, not only in the American West but worldwide. The leitmotiv of the Hinman School has been honest and thoughtful consideration of the problems of the genitourinary system gone awry. Character is the quintessence of the Hinmans. This virtue distinguishes the present volume on benign pros tatic hypertrophy assembled and edited by Frank Hinman, Jr. I first came under the spell of Frank Hinman, Sr. via his classic studies of renal counterbalance. In brief, in an experimental animal the ureter of one kidney was ligated and the subsequent renal hypertrophy of its contrala teral mate was studied quantitatively from anatomic and functional stand points. There were two central questions in the Hinman study: How does a normal kidney of an experimental animal recognize that its load has been doubled abruptly? What is the signal for renal hypertrophy? Benign hypertrophy of the prostate is quite different from compensatory hypertrophy of the kidney. It is now known that benign prostatic hypertrophy (BPH) is not a hypertrophy but a benign tumor consisting of a collection of spheroids of micro- and macrodimensions. In technical terms BPH is an adenofibromyoma. Perusal of the present volume will reveal many fascinating facets of BPH of particular interest to urologists and others with an investigative bent of BPH does not occur in children. BPH occurs as a medical rarity in mind."

In recent years, a growing interest has prompted increasing numbers of research publications and scientific conferences on the subject of urolithiasis. The aims of this symposium were three: a) to review and inte grate recent progress in major subject areas, b) to discuss current research developments and c) to stimulate interchange between investigators in Europe and in America. In a series of morning lectures, invited, recognized experts presented comprehensive reviews of major fields of urolithiasis research such as the physical chemistry of crystal formation, the metabolism of stone forming substances, and modes of therapy. A special emphasis was given to general renal physiology and the renal excretion of Ca++, Pi, Mg, oxalate and urate. Despite its obvious importance, renal function has been relatively neglected in uro lithiasis research. New research results were presented by the mechanism of after noon poster sessions. This procedure permitted informal lengthy discussions between those participants especially interested and the responsible investigator himself. In addition, informal group discussions were organized during the evenings on an ad hoc basis. In this volume, both the review lectures and brief summaries of the poster presentations have been collected. Interchange between European and American investigators was achieved by the direct participation of a large delegation from North America. This large attendance was made possible by the generous support of the National Institute for Arthritis, Metabolism and Digestive Disease U.S. N.I.H."

To present a coherent and meaningful survey of scientific research endeavour in an area that has expanded as fast as physiology and biochemistry of reproduction in the male is no mean task these days. No less prodigious than the growth of knowledge of male reproductive function has been the rate at which the outpouring of publications on this subject has continued since the appearance of 'The Biochemistry of Semen and of the Male Reproductive Tract' in 1964. Since cyclopaedic treatment of this vast literature did not appeal to us, we have made no attempt either to rehash the material contained in that book or to enlarge the bibliography beyond the nearly 3500 references included in the present treatise. At the same time, whilst writing, we felt strongly that to advance, it is necessary to understand the past, and for this reason we have not hesitated to refer (especially in the introductory chapter) to a number of those fundamental early discoveries in which today's knowledge is deeply and firmly rooted.

Nephrology, initially born as a small branch of medicine, has, in the last few decades, become an extraordinary large field of medicine. The recent development of renal medicine is mirrored by the numerous nephrological journals published, a natural consequence of the increasing number of basic and clinical research studies performed continuously all over the world. Undoubtedly the progress which has occurred in the different, specific fields of renal medicine has given rise to subspecialities which range from renal physiology and pathology to hemo- and peritoneal dialysis and renal transplantation. Even the diagnostic methodology in nephrology, very useful in the clinical practice, has become a speciality within the speciality. Thus, the problem for clinical nephrologists, as well as for internists, is to remain continuously up-dated in all fields of nephrology. Nephrology textbooks are published continuously and in great number. However, the time required for having authors appointed, chapters completed, manuscript edited, galley proofs corrected and the whole book printed makes many textbooks already out of date when they go on sale and their half lives are very short. On the other hand, nephrological journals are so many and the articles so numerous and detailed, that it is often impossible to rely on them for up-dating practicing clinicians.

Chemotherapy for malignant disease has brought about many rapid and often spectacular improvements in the survival rate of some groups of patients. Yet enthusiasm for these successes has, in part, been offset by the problems in evaluating responses to treatment and by the disappointment of failing to check the progress of still so many other tumours. These reactions will be no surprise to the medical historian but perhaps the expectations from scientific progress nowadays sometimes demand more than can reasonably be expected. Another expectation is that any review of chemotherapy is com pletely up to date, even prophetic. Such is the expansion of the subject that new drugs and trial results are continually being reported but it is this very mass of information that creates its own problems and makes many clinicians despair of finding a balanced judgement on all of this information. This was the challenge accepted by Professor Spiers. He then gathered together a group of colleagues who are amongst the acknowledged leaders in the field of chemotherapy for urological tumours, all of whom have made important contributions to this subject. However, each chapter is not merely a record of the author's experience but encompasses an assessment of past and present practice as well as perspectives in diagnosis and management. Almost all chapters include reference to published work up to and including 1981."

Cancer of the bladder has a bad reputation: the combination of urinary problems and malignancy gives just cause for continuing concern. Not only is this common cancer a burden to the patient but, because of the need for regular follow-up, it creates a large workload on the urological services. It might be imagined that the bladder would give early warning signals of disease, and indeed it may do so; yet it can also be hesitant to reveal its severity. Thus there are many problems that create challenges in the diagnosis and management. Prevention is still the first goal of an oncologist, with early detection of early disease being the next best option. Early bladder cancer is amenable to several therapeutic approaches, but we have still to determine the best approach. The management of more advanced invasive bladder cancer all too often leads to disappointment, and we remain uncertain as to the optimum approach-surgery, radiotherapy, chemotherapy or some combination of these. Although none of these problems may be fully answered either now or in the near future, many people are working towards their solution, and the rate of progress needs to be documented from time to time. This volume aims to set the standard for the present state of our knowledge on bladder cancer. The editors, Professor Ernst Zingg and Mr'. Michael Wallace, have gathered together the best opinions on a wide range of topics relating to bladder cancer.

Our insight into the mechanisms of the physiology of reproduction has experienced a swift and constant development these last few years. The advent of more sophisticated diagnostic methods and their relatively easy clinical application allow for the incorporation of that knowledge into the evaluation of the infertile couple. These facts, together with an obvious change in social psychology, have facilitated the development of different specialities dealing with the problems of infertility. It is now possible in medical centers all around the world to undertake a better disposition of the infertile husband to look for advice, to be studied, and treated. Confronted with this situation we are still unable to offer specific therapy in most cases; however, empirically based therapy abounds. Advances in therapy have not kept pace with our increased physio logical knowledge and improved diagnostic techniques. Patho physiological mechanisms and etiological factors in male infertility are largely unknown. This has significantly hampered both clinical evaluation and advances in treatment allowing for frequent non scientific therapeutic incursions into the armamentarium of the an drologist. Several factors have given birth to therapeutic "fashions," which are bound to survive as long as this state of lack of knowledge con tinues. For example, we may ask whether the treatment of varicocele constitutes a fashion? Though we accept the treatment of varicocele as the best available treatment of male infertility, we do not know its mechanism of action and so we cannot predict a therapeutic result."

A further volume in the successful 'Clinical Practice in Urology' series Urological Protheses, Appliances and Catheters, provides for the first time practical information on all those aspects of urology which depend on manufactures articles that are inserted in or attached to patients.

The renewal of interest in peritoneal dialysis as a treatment modality for patients with end-stage renal disease was stimulated by the report of Po- povich and his colleagues in 1976 on the technique of CAPD. With the in- troduction of commercial dialysate-containing plastic bags, which mark- edly reduced the incidence of peritonitis, the use of CAPD as a primary treatment modality has increased significantly. At the present time, more than 12% of the patients undergoing dialysis in the United States are utiliz- ing CAPD; however, the use of CAPD among pediatric patients is con- siderably greater. The First International Symposium on CAPD in Children was orga- nized in order to gather together experts with experience in treating chil- dren undergoing CAPD in an attempt to exchange current information on the utilization of this emerging technique in children. Since pediatric pa- tients comprise a small percentage of the CAPD population and since lim- ited data were available concerning specific methodology and complica- tions of CAPD in children, it was hoped that an international symposium would provide a forum for an exchange of experience that would ultimate- ly lead to better adaptation and increased utilization of this technique.

MRI has opened up new possibilities in combined morphological and functional imaging, and now there is a book which discusses both aspects together. Two systems which already demonstrate the advantages of MRI are presented. In the cardiovascular system, motion and flow can be imaged so that even flow velocities in the deep vessels of the body can be measured, and turbulences can be identified. In the study of the kidneys, a combination of renally excreted contrast media and imaging provides within seconds insight into glomerular filtration in health and disease. These current possibilities, and their limitations, bring insight into the future potential of MRI.

Diagnostic and exfoliative cytology has today achieved a status that few could have envisaged 20 years ago. While exfoliative cytology has long been employed in gynecological diagnosis, new and rewarding spheres have now developed in which cytological diagnosis plays an important role. Exfoliative cytology, for example, is widely employed as an aid in the continuous assessment of urinary tract tumors, and aspiration cytology in the diagnosis of thyroid dis eases. This has given rise to a growing demand for pathologists experienced in cytological diagnosis. However, clinicians with an interest in morphology were often the first to adopt these simple and safe methods, being naturally attracted by the chance to avoid conducting biopsy, which, in the last analysis, is nothing less than a surgical operation. In this Atlas of Prostatic Cytology Leistenschneider and Nagel expertly demonstrate what can be achieved when clinicians skilled in morphology take an interest in cytological methods. Not only do they have direct contact with the patient, but they also profit from immediately being in a position to assess the results of their diagnostic procedures by examining the specimen obtained. From the technical point of view aspiration biopsy of the prostate is by no means a simple procedure and the difficulties involved would seem to have been underestimated in the initial phase of enthusiastic acclaim. Consequently it has been not unusual for clinicians and pathologists to be disappointed by the high rate of unsatisfactory samples obtained by this method.

After historical introduction, the aspiration technique and imaging modalities are described. Thereafter, the use of aspiration cytology in the diagnosis and mainly in the sta- ging of urologic cancers is on still not well known appli- cations of the procedure in the staging of some organs (bladder, adrenals, penis, testis and secondary ureteral strictures) are reported.

Any discussion of the present success in management of urological cancers evokes a mixed response. Oncologists and urologists can enjoy the success with chemotherapy for testicular cancers but cannot forget the dismal results with any form of treatment, other than surgery, for renal carcinoma. But these are the less frequent urolegi cal tumours: what are the attitudes to the more common prostate and bladder cancers. Intensive study, many clinical trials and much debate lead us to the conclusion that we understand them better, we can tailor the treatment more appropriately to the individual patient but there remains some uncertainty as to the overall success that we have achieved. There have been no striking changes in the 5-year survival data. Clinicians tend to see their success in terms of their special interest. Radiotherapists point to their success in stage-reduction but what are we to do with the many patients whose tumour is unaltered by radiotherapy. Urological surgeons, and especially those who are still influenced by the shadow of Halsted, point to their success in excising the cancer but apart from that highly selected group, what are we to do for the very large number of patients for whom surgery is inappro priate. Bystanders can only watch and listen to the arguments for and against these views.

Infertility, as with many aspects of medicine, is at the mercy of rapid technological advance. Many of these developments initially seem attractive to both clinicians and patients, but need to be rigorously assessed if their real value is to be understood and clinical practice is to develop. In this book issues of importance to the management of infertile patients are discussed. The gaps in our knowledge which prevent a better understanding of the condition are identified, and recent developments, both clinical and scientific, are subjected to peer review and discussion. An important feature of the book is an acceptance that training in infertility practice is a real problem. This is perceived not only by the practising clinicians, both doctors and nurses, but particularly by the clinical scientists, including embryologists, who now provide such an essential part of the service. Similarly the provision of the clinical service has been examined in detail from a variety of standpoints, in an attempt to make sensible recommendations which balance real need with limited resource. The book is based on the papers presented and discussed at the 25th RCOG Study Group held in April 1992. The discussion after each paper was civilised but uncompromising and forms an important part of this publication. The rapid processing of the written and recorded material by the staff at the RCOG, and particularly Miss Sally Barber, has ensured that the book has been produced while the issues are live, the reviews contemporary and the discussion relevant.

In recent years the treatment of kidney stones has taken on a new dimension, thanks to modem techniques. E. Schmiedt and Ch. Chaussy revolutionized the therapy of kidney stones with their extra corporeal shockwave lithotripsy. After percutaneous fistulization of the renal cavities by ultrasonically controlled puncture became a rou tine procedure, the obvious next step was to use the same approach, after dilating the track, to carry out intrarenal operations. Dr. Knut Korth has been using this operative technique for some time now. He has gained a great deal of experience, having treated hundreds of patients who have come to him from all parts of Europe. In this book he describes the endoscopic technique which he has used in 400 cases. He does not attempt to compare and contrast his method with others, but rather describes and discusses the route he has taken. The book hence takes on a very subjective character - in the positive sense of the word. Dr. Korth believes - and emphasi zes - that puncture should be performed by the urologist himself so that the final responsibility for an operation is not divided. Our own experience in exclusively urological operations without the help of a radiologist confirm this position. Korth has developed many ideas - some in the form of instru ments - for transcutaneous operations. He describes in detail the various procedures according to the type of stone, providing nume rous examples.

This volume is a report of the proceedings of an International Symposium on Bladder Cancer and a selection of Urological papers presented at the Antwerp Medical Days in Antwerp, Belgium, on the 19th and 20th September 1980. The meeting was sponsored by the Antwerp Medical Days Program Committee supported by the Royal Antwerp Circle of Medicine, the Urological Group of the European Organization for Research on the Treatment of Cancer, the Belgische Vereniging voor Urologie, the Societe Belge d'Urologie, the Province and City of Antwerp and the National Fund for Scientific Medical Research of Belgium. Contributors were briefed to avoid too much overlapping, in the hope of obtaining a coherent compilation of clinical data. We are grateful for their discipline which enables early publication. All the contributions in this volume, except he section on immunology which was selected by the editors for its related inter est, were presented at the International Symposium under the sections 'Understanding the Disease', 'Therapeutic Approaches', 'Chemotherapy', and 'Prospective Studies'."

Anil K. Mandai, M.D., is one of the trailblazers in the use of the transmission electron microscope in the study of the urinary sediment. In this book, he reviews his extensive efforts to tie his vast clinical expe rience to his elegant basic research with the electron microscope. The pictures are comprehensive, and the clinical correlates are nicely outlined in tables and text. It may astonish some readers that a book for fellows and clinical nephrol ogists has been written on the use of the transmission electron microscope in the study of urine. Some may view this as a sophisticated research instrument. I, however, applaud the effort. So many discoveries and advances in basic science lie unutilized because clinicians are not aware of the tools available or have little instruction in their use. Maybe that is the reason why so many tests have come and gone, have been found useless and dropped, or have simply been abandoned after being judged too complicated-some because they were, others because they were never applied and interpreted properly. The whole field of research seems to be pulling ahead and away from clinical medicine. Therefore, an effort like this one, which rapidly and clearly tries to introduce an advanced research examination technique into clinical medicine, is worthy of admiration and sup port."

Any book with the words percutaneous and interventional is immediately identified as one that brings to its readers a distillation of a number of new and exciting techniques. Percutaneous is not exactly a new word but it has come to take on an entirely new meaning in recent years. Interventional is a recent acquisition to medical language indicating an entirely new approach to many aspects of medical management. Exactly when is the right time to make a distillation of new thoughts and expertise requires something of the art of a master brewer. First the ingredients must be prepared, the recipe must be just right, there must be excellent quality control as well as the master brewer's touch to produce the product when the time is right. Dr. Lang has assembled just the right ingredients in the form of a very impressive team of experts in these new fields of uroradiology and urological management. Ventures into percutaneous urology may date back 30 years but the main growth in the range of procedures and the development of the technology has occurred only in the last 10 years. Relieving upper tract obstruction seemed a natural sequel to renal biopsy but the imagination to develop an effective treatment for stones was an impressive extension of the concept of minimally invasive surgery.