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 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.

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.

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.

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.

Genetic disorders have emerged as a prominent cause of morbidity and mor tality among infants and adults. As many as 10% to 20% of hospital admis sions and at least 10% of the mortality in this age group are due to inherited diseases. There are at least two factors that have brought genetic disorders into the forefront of pediatrics. One is a great reduction in childhood mortality due to infections and nutritional deficiency states, and the other is the rapid progress made in the identification of genetic defects. Amniocentesis, chorionic villus sampling, and recombinant DNA technology have already had a tremendous impact on the practice of medicine. This is why the first two chapters of this volume are dedicated to general principles of molecular genetics and to a description of the techniques used to diagnose genetic disorders at the DNA level. The relevance of this new area of science to the study of inherited renal diseases is reflected in the large body of knowledge that has been generated regarding the association between various glomerular nephritides and genetic markers such as the HLA system, and even more impressively in the direct or indirect identification of abnormal genes or gene products in Alport's syn drome, autosomal dominant polycystic kidney disease, and Lowe's syndrome. These discoveries figure prominently in the pages of this book. Yet, the progress we have made has barely scratched the surface of the problem."

Volume 5 of Contemporary Nephrology summarizes major advances in 15 different areas of nephrology. As in previous volumes the different chapters constitute up- of the discipline contributed by individuals dates in both basic and clinical aspects with in-depth expertise in their respective areas. We are grateful to the authors for their outstanding contributions to this fifth volume. Drs. Reuss and Cotton review in Chapter 1 new advances in our understanding of water transport in epithelial tissues responsive to antidiuretic hormone. In Chap- ters 2 and 3 Dr. Knox and Dr. Schoolwerth and their associates summarize respec- tively new information in the areas of renal hemodynamics and electrolyte excre- tion, and renal metabolism. Chapter 4, written by Drs. Laski and Kurtzman, updates recent developments in the regulation of acid-base balance in health and disease. Chapter 5, contributed by Drs. Sutton and Cameron, provides the reader with a detailed account of progress in the area of mineral metabolism. In Chapter 6, Dr. Campese examines the contribution of sodium, calcium, and neurogenic factors in the pathogenesis of essential hypertension. The immunological aspects of renal disease are clearly discussed by Dr. Couser in Chapter 7. New developments in this field are emphasized and should provide the reader with a clear understanding of the direction in which this field is moving. Drs. Humes and Messana (Chapter 8) discuss selected areas in which new developments have occurred in our understand- ing of acute renal failure and toxic nephropathy.

Since the early days of medicine one concern of doctors has been the removal of kidney stones and prevention of recurrence. Owing to the hesitancy of progress in the prevention of initial stone formation and of relapse, however, removal of stones from the kidney and ureter were developed to highly refined techniques and they formerly accounted for a major proportion of the urological operations performed. In the last few years developments in the treatment of kidney stones have taken a completely different turn. In the majority of cases suit able methods are available to bring about spontaneous passage of the stones, while in a smaller proportion drug-induced litholysis is pos sible. Stones that cannot be passed are now treated mainly with extra corporeal shockwave lithotripsy, percutaneous litholapaxy or uretero renoscopy. These methods are often used in combination and comple ment each other. Nonetheless, despite the accumulating experience with the new methods there will still be situations in which stones can not be removed except by open surgery. "Our skill as surgeons and the management of the brilliantly designed equipment would amount to nothing more than highly skilled mechanical work if they did not go hand in hand with enhanced insight into the cause of lithiasis and thus into ways of preventing it - or at least of preventing the relapse that is the lot of most patients."

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.

In this book we attempt a synthesis of knowledge from two investigative extremes. On the one hand, neurophysiology and neuropharmacology are progressing via the single neuron to a subcellular level; on the other, clinicians are studying the function ofthe human urinary system in vivo as a whole. A special effort must be made over the next decade to bridge this gap. We hope that the information summarized here will catalyse the process. In 1968, de Groat and Ryall published a group of papers in the Journal of Physiology in which modern quantitative electrophysiological techniques were applied to the study ofthe reflexes that regulate bladder Junction. These papers represent alandmark in the history of bladder neurophysiology, forming a dividing li ne between old and new. The earlier techniques of lesioning and stimulation of nervous structures yielded mainly qualitative information which was open to criticism because of lack of precise control over what was actually being destroyed or stimulated. Much of this earlier work was reviewed in an authoritative volume by Bors and Comarr in 1971, entitled Neurolqgical Urology. The 16 years have seen great advances in our understanding ofthe control oflower subsequent urinary tract function.

With contributions by D. Albrechtsen, O.H. Bentdal, H. Bondevik, I.B. Brekke, P. Fauchald, J.G. Fjeld, A. Flatmark, A. Foss, A. Hartmann, H. Holdaas, R. Innes, A. Jakobsen, N.E. Klow, B. Lien, O. Oyen, P.F. Pfeffer, K. Rootwelt, G. Sodal and K. Vatne

Where do you begin to look for a recent, authoritative article on the diagnosis or management of a particular malignancy? The few general oncology text books are generally out of the date. Single papers in specialized journals are informative but seldom comprehensive; these are often preliminary reports on a very limited number of patients. Certain general journals frequently publish good in depth reviews of cancer topics, and published symposium lectures are often the best overviewes available. Unfortunately, these reviews and supplements appear sporadically, and the reader can never be sure when a topic of special interest will be covered. Cancer Treatment and Research is a series of authoritative volumes which aim to meet this need. it is an attempt to establish a critical mass of oncology literature covering virtually all oncology topics, revised frequently to keep the coverage up to date, easily available on a single library shelf or by a single personal subscription. We have approached the problem in the following fashion. First, by dividing the oncology literature into specific subdivisions such as lung cancer, genito urinary cancer, pediatric oncology, etc. Second, by asking eminent authori ties in each of these areas to edit a volume on the specific topic on an annual or biannual basis. Each optic and tumor type is covered in a volume appear ing frequently and predictably, discussing current diagnosis, staging, markers, all forms of treatment modalities, basic biology, and more."

This is a book about renal cysts and cystic kidneys. Its contributors have created a resource of current information in a field that once aroused only curiosity, but that now stands at the leading edge of molecular nephrology. Its authorship includes 'oldtimers', who bring the wisdom of experience, and 'newcomers', whose presence attests to the contributions made by the investigative and technological advances of the past decade. Its text is organized to carry the reader from renal cyst to cystic renal disease. Each of its chapters defines or explores a challenge or an advance. Cells that line renal cysts are diverse in structure, type, and perhaps function. The cysts themselves lie within an interstitium that is not normal and may influence cyst development and growth. Experimental analogs of human disease offer increasing opportunities to basic researchers to examine, in sequence and under controlled circumstances, those events that favor nephron dilation, cyst growth and ultimate renal failure.

practitioner up to date on the various aspects of conditions and diseases considered to be sexually transmitted. REFERENCES 1. Crissey JT, Denenholz DA: Development of the modern forms and concepts of syphilis. Clin Dermatol, 2(1):1-10, 1984. 2. Panconesi E, Mazzi M: The day syphilis came. Int 1 Dermatol, 23:284-286, 1984. 3. Washington AE, Johnson RE, Sanders LL: Chlamydia trachomatis infections in the United States: What are they costing us? lAMA, 257:2070-2074, 1987. 4. Bulkley LD: Syphilis in the Innocent. New York: Bailey and Fairchild, 1894. 5. Syphilis: Major perinatal killer. Med World Trib, 28(16):2, 1987. 6. Renshaw DC: Management of impotence. I. Psychological considerations. Clin Therap, 9:142-148,1987. Acknowledgments. We are very grateful to our teachers for the stimulation they provided in our studies of dermatology and sexually transmitted diseases. We partic ularly acknowledge the impetus given by Herman Beerman, M.D., Emeritus Professor of Dermatology, University of Pennsylvania School of Medicine, Philadel phia. Our office staffs have been particularly helpful, and we would like to recognize the contributions of Mrs. Carmela Ciferni. Lastly, this book was conceived through the inspiration of Dr. Jerry Stone, late Senior Medical Editor of Springer-Verlag, New York. Philadelphia, Pennsylvania LAWRENCE CHARLES PARISH Vienna, Austria FRIEDRICH GSCHNAIT Contents Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Xl . . . . . . . . . . . . . . . What are Sexually Transmitted Diseases? Chapter 1 History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 . . . . . . . . . . . . . LOIS Y. MATSUOKA Chapter 2 Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . . . . HARRY L. ARNOLD, JR. Diseases Chapter 3 Syphilis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 . . . . . . . . . . . . . JOHN THORNE CRISSEY Chapter 4 Endemic Treponematoses . . . . . . . . . . .. . . . . . . . . . . . . . . . 32 . . ."

CHARLES Y. c. PAK Major progress has been made in the pathophysiologic elucidation and management of nephrolithiasis during the past two decades. It is now possible to detect the cause of stone disease in more than 95% of patients, to prevent recurrent formation of stones in the majority of patients, and to remove most existing stones less invasively. The assumption of editorship of this book permits me to indulge in the discussion of this progress from my personal perspective. Three somewhat fortuitous events in my academic career dictated my directing major efforts in stone research. The first event occurred in 1963 when, after having completed medical training, I was faced with two years of military service as a participant of the Berry plan. Choices were limited and disconcerting for someone interested in a research career: a staff physician at a military installation or an indian reservation, or a member of a research team in a state penitentiary. An interesting article by Norman Gershfeld on phospholi pid monolayers prompted me to write him seeking a position in his laboratory of Health (NIH) in Bethesda, MD. Partly because of at the National Institutes my rudimentary exposure and publication in surface chemistry, I was offered a position as a staff scientist and a position in the Public Health Service which satisfied the requirements of a military service."

This atlas deals with conditions commonly encountered in the male genital tract. Whilst the majority of illustra tions are photomicrographs, photographs of macro scopic specimens are also used to illustrate important features in distinguishing different pathological con ditions. Special emphasis is placed on the small biopsy specimens obtained from prostate and testis in modern urological practice and the importance of clinico pathological co-operation in pathological practice is stressed. Recent advances in our knowledge of testicu lar tumours are discussed and illustrated. The text is not entirely descriptive and attempts to give an intellectual framework around which histopathological diagnosis in this field can be practised. A modest number of references are included; they have not been singled out as representing milestones in the development of our knowledge of these conditions - the choice has rather more centred upon recent reports from which a litera ture search can be mounted if required. The atlas in no way pretends to be an encyclopaedic reference of con ditions of the male genital tract but attempts to provide an up-to-date comprehensive discussion of the histo pathology of this system. Acknowledgements I am most grateful to Mr Keith Gordon for developing all the photomicrographs and to Mr Geoff Gilbert and his staff in the Audio-Visual Department of the City Hospital who took the majority of the macroscopic illustrations. I must particularly thank my secretary, Mrs Dorothy Clay ton, for typing and retyping my draft chapters and for deciphering my hieroglyphics."

This volume contains the proceedings of the XVth North American Testis Workshop, held in Louisville, Kentucky, April 7 to 10, 1999, to describe current advances in testis biology. The first two chapters provide a useful historical perspective of testis physiology and formulate compelling research questions about important aspects of sperm formation and function. This prologue sets the scene for the remainder of the volume that follows a logical progression, as the title implies, from stem cell to cell function, but that is necessarily preceded by sex determination, the quintessential requirement for there being a testis in the first place. The program for this XVth Testis Workshop evolved from recommenda tions of the scientific committee and their advice on the selection of invited speakers. The XVth Testis Workshop has a strong comparative flavor with contributions on worms (Caenorhabditis), flies (Drosophila), and chickens, which are models that permit and thereby reveal the power of genetic analy ses of the molecular mechanisms involved in spermatogenesis. A glimpse into the future is provided with information from EST, protein, and genome databases that already have an impact on progress in our understanding of the male germ cell. Although there is heavy emphasis in these chapters on cellular and molecular e, Yents, database mining and translational profiling relevant to testis function and dysfunction and assisted reproduction tech nologies are not overlooked."

During recent decades, it has been firmly documented that chlamydiae are com mon and important pathogens in humans and animals. In humans, chlamydiae are known to cause trachoma (which is still one of the major blinding diseases in the world) and are also one of the most common etiological agents of sexually transmitted diseases and the sequelae thereof, such as infertility. In the last few years, it has also become evident that chlamydiae, i.e., the so-called TWAR agents, are common respiratory tract pathogens. Chlamydiae are also important pathogens in birds and lower mammals, in whom they cause a variety of infectious conditions, a spectrum which has in creased every year. Some of these infections occur as zoonoses, e.g., psit tacosis/ornithosis and, as recently discovered, abortion. Know ledge of the molecular biology and immunobiology of chlamydiae has expanded rapidly during recent years. Insight into the pathophysiology of chla mydial infections has also increased, and new methods for the diagnosis of chlamydial infections have been introduced. The importance of establishing control and preventive programs for chla mydial infections has become obvious in order to combat the present chlamydial epidemic. We hope that this book can usefully serve those who want to increase their general knowledge of Chlamydia and that it can act as a handbook and reference source for those involved in chlamydial research as well as for those working with chlamydial infections in medical and veterinary clinical disciplines, includ ing clinical laboratories."

A central concept in the evolutionary theory of senescence is the idea that ageing results from life-history trade-offs. In particular, the disposable soma theory suggests that longevity is determined through the setting of longevity assurance mechanisms so as to provide an optimal compromise between investments in somatic maintenance (including stress resistance) and in reproduction. Comparative studies among mammalian species confirm that cells from long-lived species appear to have a greater intrinsic capacity to withstand stresses than cells from short-lived species. Childbearing at older ages has become increasingly common in modern societies because of demographic changes, medical progress and personal choice. While the detrimental effects of late reproduction on infant mortality and genetic diseases have been well documented, little is known about the possible postponed detrimental effects of late parenting.

Technology seems to be an integral part of modern living. Urologists have over the years embraced new technological advances for patient beneft. On some occasions, however, the initial enthusiasm in something new has failed to endure rigorous scientifc scrutiny. Thus, while being technological leaders, we urologists know better than most other surgical speci- ties that what is new is not necessarily good. This textbook is aimed at urologists and surgeons at all levels and has contributions from international experts. The topics vary from robotics to lasers to single port laparoscopy. The comprehensive chapters should be of equal interest to uro-oncologists and those involved in treating benign urological diseases. While the contents are meant to bring the reader up to date with technological advances, the authors have attempted to balance their enthusiasm with basic science, translational research, and clinical outcomes. It will be obvious that some of the s- jects mentioned here, such as nanotechnology, are still evolving, and it will be a while before they undergo clinical trials that establish their position in clinical medicine. We hope you enjoy reading this book as much as we have enjoyed creating it. London, UK Prof. Prokar Dasgupta Dublin, Ireland Prof. John Fitzpatrick London, UK Prof. Roger Kirby CA, USA Prof. Inderbir S. Gill vii Acknowledgements The editors thank all authors for their time and valuable contributions. We are also grateful to our developmental editors Joni Fraser and Barbara Lopez-Lucio.

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.

All unsuccessful revolutions are the same, but each successful one is different in its own distinctive way. The reason why revolutions occur is that new forces attain increasing significance and classic institutions are incapable of accomodating these forces. Such has been the pattern of events in the English, American and French revolutions. These successful revolutions produced a new dynamic and new perspectives. One English revolutionary put this succinctly: "Let us be doing, but let us be united in doing." This book sets out what is a revolution in. the perspectives of diagnostic imaging of the kidney and urinary tract. Forces which have brought about this revolution are the advent of reliable techniques in radioisotope studies, ultrasonics and computerized tomographic (CT) scanning. This last modality carries with it specific problems for routine paediatric work and its role in the study of kidney and urinary tract problems is discrete and circumscribed. However, in conjunction with classic radiology, each of these techniques yields information of a different type and so a synthesis of data accrues.

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.

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.