Die grundlegend aktualisierte 2. Auflage bietet einen einzigartigen und fachA1/4bergreifenden Aoeberblick zu den Grundlagen, urologischen und orthopAdischen Details sowie psychosozialen und juristischen Aspekten der Spina bifida. Fallbeispiele machen das Buch besonders fA1/4r Studenten, praxisnah arbeitende A"rzte und auch Physiotherapeuten attraktiv. komplett A1/4berarbeitete und ergAnzte 2. Auflage praxisnah und aktuell neu gestaltete Abbildungen

For doctors and students who wish to learn ultrasonography concisely yet comprehensively. The authors present the subject both systematically and practically, and with the facility of quick reference in mind, making generous use of flow-charts, tables and teaching-points. All general aspects of diagnostic ultrasound are covered, concentrating on those disorders encountered in the daily routine of scanning, but also referring to rarer conditions which need to be considered in differential diagnosis.

Urinary incontinence is a humiliating disability and a common problem in gynaecological clinics. In some centres specialised facilities are avail able for its investigation and treatment but in most hospitals the general gynaecologist has to manage this difficult condition. For both generalist and subspecialist it is timely to summarise advances in our knowledge of normal and abnormal micturition. Since 1973 the Royal College of Obstetrician's and Gynaecologists, through its Scientific Advisory Committee, has convened Study Groups on important growth areas in our specialty. The College invites an international panel of leading researchers to participate in a workshop, allowing time for in-depth discussion as well as the presentation of papers. It is hoped that this will produce not only an up-to-date sum mary of current knowledge but also a useful interaction between indi viduals and between specialties. This book is the result of the 21st Study Group, which was held in October 1989. The participants included urological and colorectal surgeons and a neurologist, as well as scientists and gynaecologists. The meeting began with sessions on basic science and advances in the investigation of the lower urinary tract, then covered voiding diffi culties, genuine stress incontinence and detrusor instability, before a final session on the relationship between urinary incontinence and ali mentary tract problems. The discussions formed an essential part of the meeting, and it is hoped that the lightly edited versions reproduced here will convey to the reader the stimulating atmosphere of the Study Group.

Urinary tract infection remains one of the most common reasons for an individual seeking medical advice. Although the associated morbidity varies widely in adults, such infections are less common but may constitute severe, life-threatening illness in children and in the elderly. Diagnostic tests and treatment have been rationalized in recent years but many practising doctors still have difficulty in appreciating the patho-physiological principles involved. Particular difficulty is often experienced when treating patients with recurrent urinary tract infections, covert bacteriuria, vesico-ureteric reflux, elderly patients and those with indwelling catheters. These topics are fully discussed in this volume. Each chapter has been written by a recognized expert and practical aspects of patient management have been emphasized. The information presented in this volume should prove of interest not only to nephrologists but to all practising clinicians. VII ABOUT THE EDITOR Professor Graeme R. D. Catto is Professor in Medicine and Thera peutics at the University of Aberdeen and Honorary Consultant Phy sician/Nephrologist to the Grampian Health Board. His current interest in transplant immunology was stimulated as a Harkness Fellow at Harvard Medical School and the Peter Bent Brighton Hos pital, Boston, USA. He is a member of many medical societies includ ing the Association of Physicians of Great Britain and Ireland, the Renal Association and the Transplantation Society. He has published widely on transplant and reproductive immunology, calcium metab olism and general nephrology."

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."

Presented by recognised experts around the world this reference book helps identify the role of medical and surgical therapies in the treatment of Benign Prostate Hyperplasia (BPH), prostate cancer and prostasis. By combining the latest epidemiological data with detailed comment on management and treatment, the book is a unique up-to-date and fully referenced resource on the subject.

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.

Erectile dysfunction can affect all age groups. Numerous physical and emotional risk factors may contribute to the problem. These risk factors can range from chronic diseases and medications to psychological factors. In the U.S. alone, it has been estimated that 18 to 30 million men suffer from erectile dysfunction. This number has increased significantly as awareness of the disorder has heightened. Researchers and health care professionals now have a better understanding of what causes erectile dysfunction and the effective medications and non-medication treatments used to treat the condition. Comprehensive and state-of-the-art, Contemporary Treatment of Erectile Dysfunction: A Clinical Guide synthesizes the literature and covers all aspects of treating erectile dysfunction and other related male sexual dysfunctions. This invaluable title offers all physicians, residents, and fellows -- and even medical students and other health professionals such as nurse practitioners and physician assistants -- an essential reference for enhancing diagnosis and treatment of this debilitating disorder.

Malignancies originating from the urogenital tract account for about 20% of all solid neoplasias. The various tumor types, including carcinoma of the prostate, transitional cell carcinoma, renal cell carcinoma, and testicular germ cell tumors, differ widely in terms of biological features, in cidence and appearance, diagnostic work-up and manage ment. It is not surprising that this complexity of urologic oncology with its related problems has increasingly attracted both experimental investigators and clinical experts. Only time will tell whether the achievements that today are con sidered* as progress will turn out to be significant contribu tions towards the ultimate goal: the cure of the patients' life-threatening diseases with little or no side effects. How ever, many innovations and improvements have already taken place in the field of urologic oncology within recent years. The high pace of innovative development requires continuous, thorough, and critical updating of our kowledge so that persisting deficits can be defined: the basic require ment for posing new scientific questions. The following examples may serve to illustrate the recent developments and the resulting new problems and questions: Recently, it has become evident that carcinoma of the prostate must be detected earlier to enable us to cure more of the affected patients in the future than currently.

In February 1980 the Royal College of Radiologists, London, held its Second Symposium on Clinical Oncology. The subject was Prostatic Cancer and this publication is based on the presen tations at this meeting by leading authorities in the United Kingdom. The principal objective of these Symposia is to promote multi disciplinary collaboration for the benefit of cancer patients. Awareness and understanding of advances in a broad range of subjects are essential to ensure the timely and effective appli cation of new techniques in the prevention and treatment of all forms of cancer. Communication of this kind may also stimulate the creation of new ideas that may prove to be of more fundamental relevance to cancer research. Prostatic cancer has been afforded too little attention in the past, and its importance in Clinical Oncology has not been adequately recognised. And yet over the last 10 years consid erable progress has been recorded in our understanding of this disease and in its assessment and management. These achieve ments are well documented in this collection of papers and the outstanding problems are also clearly indicated. It is acknowl edged that the early diagnosis of prostatic cancer presents a continuing challenge, associated with the uncertainties that concern the clinical significance of 'latent' cancer of the prostate. The accurate assessment of the incidence and preva lence of the disease is extremely difficult and together these problems complicate the evaluation of the management of early or localised prostatic cancer."

This book is the product of long years of close collaboration between two physicians, a pediatric endocrinologist and a pediatric surgeon, who are interested in the complex field of human malformations. Their efforts have set a new standard in the treatment of children with intersexual or mal formed female genitalia. It is impossible to convey the details of complex surgical procedures without the help of meticulous illustrations. It is fortunate that happened to meet an academically trained artist, Mrs. Siri Mills, M.A., while visiting in the United States. Her excellent knowledge of anatomy, her remarkable skills as an artist and technical illustrator, and her readiness to include all details of interest to the surgeon have found their fruitful expression in the illustrations of this book. We express our thanks to Springer-Verlag and especially to Prof. Diet rich Goetze, at whose suggestion this book was written, for their amiable compliance with all our wishes, and particularly for their willingness to retain Mrs. Mills as our illustrator. Munich, May 1985 WALDEMAR HECKER Contents In trod ucti on 1 Part 1: Endocrinologic Diagnosis in Pediatric Patients with Genital Anomalies General Rules . . . . . . . . . . . 4 Endocrinology of Antenatal Sex Differentiation 6 Male Differentiation 6 Female Differentiation 7 Specific Endocrinologic Diagnosis and Therapy 8 Virilization of the Female External Genitalia 8 Congenital Adrenogenital Syndrome with a Defect of 21-Hydr- ylase . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Intersexual Genitals Due to Deficient Androgenization of the Male 11 Defects of Testosterone Biosynthesis 11 Androgen Receptor Defects . . ."

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.

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.

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.

Decoding the significance of proteinuria as an indicator of severity or prognosis in kidney disease is a stimulating challenge to students and practitioners of nephrology. Sir Richard Bright in 1827 associated pro with the disease that bears his name. In the subsequent more teinuria than a century and a half, however, the meaning of the linkage between proteinuria and renal disease remains elusive. Proteinuria is discovered on routine urinalysis in about 10 million Americans, most of whom express no symptoms of kidney disease, each year. From the studies of Robinson (updated in these pages), we know that proteinuria, per se, can be present for 20 years without change in re nal function, as described in orthostatic proteinuria. By contrast, pro teinuria may be the harbinger of swift kidney destruction, rarely cul minating in clinical collapse, a syndrome typifying "malignant proteinuria" as detailed herein by Avram. Although proteinuria is ubiquitous, an orderly management strategy for rational handling of proteinuria of less than nephrotic range is lack ing. Separation of tubular proteinuria and transient proteinuria of fever is now possible routinely. This book provides a record of the contribu tions of investigators and clinicians whose work forms the substrate for production of understanding and, ultimately, marching orders for prac titioners seeking optimized management for their proteinuric patients."

In the 5 years since the publication of Urologic Laparoscopy by the Japanese Society of Endourology and ESWL, the field has moved on apace, particularly technologically. It is with an eye on the need to disseminate the latest information on this progress that this collection has been assembled, highlighting the most recent advances in laparoscopic urologic oncology surgery. With treatment options becoming ever more complicated, it is essential to keep the prime objectives in mind - improved quality of life for the patient, minimal complications, early convalescence, and a better end result. In our effort to cover a broad range of techniques from renal cyst decortication to robotic laparoscopic camera control, we are in debt to surgeons at the forefront of treatment, not only in Japan but worldwide, and to manufacturers who are constantly innovating in their equipment. The contributors are enthusiastic in their expertise, as shown in the quality of the material they have produced.

This book provides a comprehensive reference and practical guide on the application of US to penile diseases and conditions. After introductory chapters on technical requirements and penile anatomy, subsequent chapters offer a systematic overview of the diverse applications of color Doppler US. The topics covered include erectile dysfunction, Peyronie's disease, priapism, trauma, tumors, the postoperative penis, inflammation, and fibrosis. Each topic is introduced by a clinical overview with the purpose of clarifying the problems and elucidating what the urologist may expect from color Doppler US. Thereafter, performance of the US study is explained and the pathological anatomy reviewed. High-quality images obtained with high-end US equipment are included. Each chapter also contains a section on the diagnostic information provided by other imaging modalities, and in particular MRI.

This collection of 21 articles is designed to serve as a state-of-the art reference book for intersexuals, their parents, health care professionals, ethics committee members, and anyone interested in problems associated with intersexuality. It fills an important need because of its uniqueness as an interdisciplinary effort, bringing together not just urologists and endocrinologists, but gynecologists, psychiatrists, psychologists, lawyers, theologians, gender theorists, medical historians, and philosophers. Most contributors are well-known experts on intersexuality in their respective fields. The book is also unique in that it is also an international effort, including authors from England, the Netherlands, Germany, Australia, India, Canada and the United States. The book begins with introductory chapters on the etiology of intersex conditions, conceptual clarification, legal issues, and reflections about the inherent characteristics of medical care that have led up to the issues we face today and explain the resistance to change in traditional practices. Researchers provide recent data on gender identity, surgical outcomes, and appropriate clinical care. Issues never having been addressed are introduced. The significance of intersexuality for Christianity and for philosophical concerns with authenticity add further depth to the collection. The final chapters deal with future possibilities in the treatment of intersex and for intersex advocacy.

Prostate biopsy is now one of the most common procedures performed by urologists. This book presents all topics related to the diagnosis of prostate cancer, including risk factor assessment, indications for biopsy, techniques, complications, and emerging technologies in the science. It also covers such important topics in prostate biopsy as PSA, pain prevention, prediction models, and biopsy techniques. The book 's contributors include those who have defined the science of prostate cancer diagnosis and continue to improve upon it. These internationally acclaimed specialists provide their expert opinions on all topics related to prostate cancer diagnosis.

- With a dramatic increase in knowledge of anorectal physiology and imaging over the last five years, this book provides a comprehensive study of anorectal assessment.

- Explores all the lastest techniques and treatments in the field

- Organized into two, easy to manage, sections

- First book to pull a diverse area together and includes 3-D ultrasound, transperineal ultrasonography and dynamic MRI not found in other texts on anorectal disorders

Emergencies in Urology is a comprehensive textbook covering one of the few remaining white spots on the map of urological literature. To date only a small number of publications have been dedicated to the topic of urgent and emergent problems in urology important as these are in our daily clinical life.Therefore the editors, both of them internationally recognized urological experts, have taken the effort to present an in-depth study into virtually every possible urgent urological situation with which a urologist may be confronted today. Consequently, the book includes chapters on topics such as urological trauma, urosepsis, urinary obstruction, oncological emergencies, intra- and postoperative complications, acute problems in children, and many more.To obtain the best possible expertise in such a wide field, renowned expert authors have contributed their experience to this book. They did so not only by writing the regular book chapters but also by delivering short stories about urgent situations they encountered in their own professional life. These vignettes are one of the rare opportunities where experience can be relayed without restriction from one urological generation to the next.Much work has gone into the illustrations for the book. Foremost in this respect is the art of Stephan Spitzer, one of the leading medical illustrators of today.The result is a comprehensive, well-organized text, in which state-of-the-art know-how, didactic algorithms, personal experience and detailed illustrations are combined into a unique guide of how to manage urological emergencies."

- Over 200 exquisite illustrations, ranging from intraoperative photographs, line drawings, diagnostic images, pathology slides, tables and graphs are available to make each case discussed comprehensible and easy to follow.

- Traditional and novel therapeutic recommendations are introduced and the latest developments in minimal-access operative techniques are discussed and reviewed.

- Focuses on a teamwork oriented approach that identifies the necessary communications amongst the many medical disciplines when dealing with adrenal disorders.

Exciting new developments and applications of imaging techniques have emerged over the last few years, leading to many improvements in diagnosis and staging of urologic diseases. Refinements in the technology mean that imaging now is much more precise than even five years ago, and this has significantly enhanced its application within several key fields.

As such, there are virtually no books currently available that cover the impact of these advances within urology leaving a major hole in the market. With its sound overview of the current state of affairs, and also its focus on highlighting future advances, this book would therefore find a significant audience within not only trainees, but also practicing clinicians too.

Furthermore, the whole topic of ultrasonography is a relatively overlooked one, with very few modern books tackling any specific areas of the field. This book will be up-to-date and will pay attention to the unique applications of ultrasound within each discipline.

"Rule IV. There is need of a method for finding out the truth. Rule V. Method consists entirely in the order and disposition of the objects toward which our mental vision must be directed if we would find out any truth. We shall comply with it exactly if we reduce involved and obscure propositions step be step to those that are s- pler, and then starting with the intuitive apprehension of all those that are absolutely simple, attempt to ascend to the knowledge of all others by precisely similar steps. " -Rene Descartes, Rules for the Direction of Mind ..".Perhaps he would sooner satisfy himself by resolving light into colours as far as may be done by Art, and then by examining the properties of those colours apart, and afterwards by trying the effects of reconjoyning two or more or all of those, and lastly by separating them again to examine what changes that reconjunction had wrought in them. This will prove a tedious and difficult task to do it as it ought to be done but I could not be satisfied till I had gone through it. " -From Newton's letter, quoted in The Life of Isaac Newton by Richard Westfall. Cambridge University Press, 1993.

This eighth volume in the series Recent Advances in Endourology brings together the latest clinical findings regarding various endourological treatment modalities and innovative materials. World-recognized experts outline their techniques clearly and concisely to provide an updated review of state-of-the-art endourological techniques. International management of urological diseases is focused in this latest issue.