The advent in the 1960s of the unique and exciting new form of energy called laser brought to medicine a marvelous tool that could accomplish new treatments of previously untreatable disorders as well as improved treat ment of mundane problems. This brilliant form of light energy is many times more powerful than the energy of the sun yet can be focused microscopically to spot sizes as small as 30 microns. Lasers can be directed into seemingly inaccessible areas by mirrors or fiberoptic cables or can be directly applied into sensitive areas such as the retina without damage to intervening structures. There has been a rapid proliferation in the use of lasers in all surgical specialties. Starting with bold ideas and experiments of "thought leaders" in each specialty, the application of lasers has evolved into commonplace usage. Beginning with the era when laser presentations and publications were an oddity, now nearly all specialty areas have whole sections of meetings or journals devoted exclusively to laser usage. Laser specialty societies within a specialty have developed and residency training programs routinely instruct trainees in laser techniques. Basic science and clinical experimentation has supported laser knowledge. Laser usage has also become international. Newer wavelengths and accessories have added to the armamentarium of laser usage. Despite the rapid growth in laser interest, no single source exists to instruct the many new laser users in proper, safe, and effective use of this new modality."

This volume is concerned with the clinical aspects of urology in childhood; the anatomy, physiology and pathology are discussed only where they have a direct bearing upon the clinical problem, and for a detailed description of these aspects, and of operative technique, the reader is referred to other volumes of this series. Emphasis is laid upon the disorders peculiar to infants and children, so that diseases such as tuberculosis, the manifestations of which in the child differ little from those in the adult, receive less attention. Childhood is deemed to cease with the completion of puberty, though illustrations have sometimes been taken from adolescent cases. The personal views expressed in this work are based upon experience at The Hospital for Sick Children, Great Ormond Street, at St. Peter's and St. Paul's Hospitals, and at the Institute of Urology, University of London. I am deeply indebted to all my colleagues and assistants at these institutions for their help and co-operation both in the trea.tment of cases and in the preparation of this volume. I would particularly wish to thank Mr. T. T. TwrSTINGTON HIGGINS for introducing me to the urology of childhood, Drs. M. BODIAN, R. C. B. PUGH and L. L. R. WHITE for their assistance in matters of pathology, and for preparing specimens for illustration, Dr. "\V. W. PAYNE for his advice on biochemistry, Dr.

The 6th triennial meeting of the International Study Group for Tryp- tophan Research (ISTRY) was held May 9-12, 1989 in Baltimore, Maryland (USA). From the wide variety of topics and disciplines represented, as documented in this volume, it is clear that tryptophan research and ISTRY are alive and well. ISTRY traces its or1g1ns to at a tryptophan symposium organized in 1971 by H. Schievelbein at Hohenried near Munich (Germany). Up to that time there had been occasional international tryptophan conferences at irregular inter- vals. A number of participants at the Hohenried meeting felt that an inter- national tryptophan organization should be formed to organize regular meet- ings and to foster collaboration and information exchange on tryptophan-re- lated topics. Thanks mainly to the founding work of H. Schievelbein and W. Kochen, an executive committee was elected and ISTRY was born. The inaugural meeting in 1974 was held in Padova (Italy) to honor L. Musajo, one of the foremost pioneers in tryptophan studies. This first ISTRY meeting was suc- cessfully organized by L. Musajo, G. Allegri, A. De Antoni, and C. Costa, and was critical in assuring the viability of the new organization. Subsequent meetings were held in 1977 in Madison, Wisconsin (USA), organized by R.R. Brown, D.P. Rose, and W.E. Knox, honoring C.P. Berg; 1980 in Kyoto (Japan), organized by O. Hayaishi, R. Kido, Y. Ishimura, T. Deguchi, T. Hino, T.

"People . . . see you sweat in agony, turn pale, turn red, trem ble, vomit your very blood, suffer strange contractions and con vulsions, sometimes shed great tears from your eyes, discharge thick, black and frightful urine, or have it stopped up by some sharp rough stone that cruelly pricks and flays the neck of your penis. " * These 16th century frustrations of Michel de Montaigne which most graphically reflect his experience with renal colic still plague approximately 1 per 1000 individuals in the United States annually. Since as many as 75% of clinically. apparent episodes of renal colic represent single nonrecurring events, physicians not in frequently approach the differential diagnosis of nephrolithiasis in a less than adequate fashion and assume that the incident may prob ably never recur after the single attack. However, the ureteral or bladder stone actually represents one form of abnormal crystalline precipitation; parenchymal nephrocalcinosis, silently progressive azotemia, and asymptomatic renal pelvic calculi may also stem from the same pathological process(es) which conditioned the for mation of the ureteral or bladder stone. In this regard it is worth emphasizing that the postmortem incidence of renal calculi is some tenfold greater than that presumed from surveys wherein a clinical attack of nephrolithiasis is the sole determinant. *In Familiar Medical Quotations. M. B. Strauss, Ed. Little Brown, Boston, 1968, p. 646. v vi FOREWORD The last decade has witnessed the birth of new knowledge in urolithiasis research."

Ferment, a sign of progress in any scientific field, has previously been lacking in the area of cryptorchidism, where the only activity has been in improving operative methods. Now, however, profound changes in the care of boys with cryptorchidism are being brought about; ideas are arising from a fresh look at comparative anatomy, and histological and experimental observa tions are being supplemented by clinical tests made possible by new hormonal agents. The treatment of cryptorchidism begins with its recognition by the pediatri cian, who until now has shown little interest because of disappointing results from chorionic gonadotropin administration. As for the surgeon, his bent toward restoration of normal anatomical relationships has kept his attention focused on the development of better surgical technics to bring the recalci trant testis into the scrotum. Both specialists have avoided the primordial question of why the testis did not descend properly. If this were known they would treat the cause of cryptorchidism, and not be satisfied merely with trying to correct its end result. As one reads this book, one sees that in most patients cryptorchidism is not caused by some anatomical structure blocking the way or by some deformity of the testis interfering with the transport mechanism. Rather, deficiencies in the hormonal environment of the fetus retard the developmen tal sequences essential to the normal differentiation and descent of the testis. The clinical solution is thus to provide the deficient substances."

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."

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."

Urology Lecture Notes contains all the essential knowledge for medical students, junior doctors and early-stage trainees involved in urology placements or urological surgery. With a strong emphasis on clinical presentation, procedures and surgery, it provides an accessible, conversational guide to all the situations likely to be encountered on the wards. Key features include: Extensive illustration to clearly demonstrate relevant procedures, conditions, and physiology Important information flagged up in key points Self-assessment MCQs to test and help consolidate knowledge Whether you are preparing for your first urology rotation or looking for a quick reference to all aspects of the system, Urology Lecture Notes provides key support to all students, junior doctors and trainees involved in this specialty.

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."

A vast number of children in the United States are evaluated and treated for urologic conditions by urologists practicing general urology due to the relatively few fellowship-trained pediatric urologists. Pediatric Urology: A General Urologist's Guide is written specifically for general urologists as a concise and comprehensive reference of the more common pediatric urologic conditions. Other health practitioners (i.e. pediatrician, family practitioner, residents, medical students, and mid-level providers) will also find this book a key reference. Written by well-respected pediatric urologists, this volume will assist the health care provider to rapidly review the essential aspects of the physical examination, evaluation, diagnostic testing, and management while the patient is still in the office. The chapters are arranged into four sections to allow for easier access to the information: office urology, genitalia, urinary tract, and miscellaneous topics. Furthermore, the first chapter of the book will be dedicated to facts and figures (ex. normal penile and renal lengths based on age, dosing of common medications, and grading system for vesicoureteral reflux) that serves as a single source for this information. Pediatric Urology: A General Urologist's Guide offers the reader the essential information to assist them in the care of children.

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.

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 first International Symposium on Urolithiasis Research was held in Leeds, England, in 1968. The meeting was the first in what was to become a series of symposia intended to gather together a diverse group of biochemists and physicians, urologists and engineers, with a common interest in factors affecting the formation of human urinary stones. Since its inception the series has threaded a peripatetic course back and forth across the Atlantic Ocean, from Madrid in Spain, to Davos in Switzerland, to Williamsburg in the USA, to Garmisch-Partenkirchen in Germany and Vancouver in Canada, under the guardianship of Drs Nordin, Cifuentes Delatte, Fleisch, Smith, Schwille, Dirks and Sutton, and their colleagues. In 1992, for the first time, the meeting moved to the southern hemisphere, to Cairns in Northeastern Australia. Unlike most previous symposia, there were no invited papers. Instead, the submitted abstracts were allowed to dictate the content of the meeting so that the conference programme would reflect the flavour of current research in the field. To achieve this, all abstracts were graded anonymously by three referees to determine their categorization as oral, theme poster, or general poster presentations. The 300 or so accepted absracts were then allocated to seven plenary sessions, nine theme poster discus sion groups and three large general poster sessions."

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."

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.

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."